I 


THE  CENTURY  BOOK 
FOR  MOTHERS 


THE    CENTURY    BOOK 
FOR    MOTHERS 


A  PRACTICAL  GUIDE 
IN  THE  REARING  OF 
HEALTHY  CHILDREN 

BY 

LEROY  MILTON  YALE,  M.D. 

FORMERLY  LECTURER  ON  THE  DISEASES  OF  CHILDREN 

AT  BELLEVUE  HOSPITAL  MEDICAL 

COLLEGE,  NEW  YORK 

AND 

GUSTAV   POLLAK 

EDITOR  OF  "BABYHOOD" 


THE   CENTURY   CO. 
NEW  YORK  .  .  .  1908 


Copyright,  1901, 
By  The  Century  Co. 

Published,  October,  190L 


The  DeVinne  Press. 


PREFACE 

IN  preparing  "The  Century  Book  for  Mothers"  the  au- 
thors have  endeavored  to  keep  in  mind  two  queries :  What 
ought  an  intelligent  mother  to  know,  and,  beyond  that,  what 
would  she  wish  to  know,  regarding  the  care  of  her  child? 

As  regards  the  first,  the  writers  have  believed  that  she 
should  understand  matters  of  hygiene  rather  than  the  treat- 
ment of  diseases;  that  she  should  know  the  things  which  go 
to  the  establishing  and  preserving  of  healthful  conditions; 
and  that  she  should  be  aided  in  the  recognition  and  avoid- 
ance of  disease,  rather  than  in  its  cure.  In  other  words, 
their  object  has  been  to  help  the  intelligent  mother  to  be- 
come the  alert  and  judicious  guardian  of  the  nursery,  rather 
than  to  tempt  her  to  play  the  physician  and  to  dabble  in 
dosing.  In  the  first  part  of  the  book  special  emphasis  has 
been  laid  on  the  caring  for  children,  including  the  feeding, 
clothing,  and  housing.  The  subject  of  diseases,  systemati- 
cally even  if  somewhat  briefly  discussed  in  Part  I,  receives 
additional  treatment  in  Part  II. 

As  to  the  inquiry— What  kind  of  information,  beyond 
what  she  ought  to  possess,  is  the  mother  likely  to  seek?— 
the  writers  could  think  of  no  better  way  of  giving  such  in- 
formation than  to  follow  the  questions  actually  put  by 
mothers  to  them  as  editors,  for  many  years,  of  a  magazine 
devoted  to  the  care  of  children.  The  second  part  of  the 
book  is  therefore  almost  entirely  made  up  of  a  large  number 

vii 


viii  PEEFACE 

of  questions  concerning  the  many  perplexities  of  daily  nur- 
sery life,  together  with  the  answers  furnished.  The  authors 
believe  that  in  so  doing  they  have  more  nearly  approached 
the  mother's  point  of  view,  and  better  met  her  needs,  than 
by  any  systematic  treatment  of  nursery  matters  they  could 
have  devised.  Their  aim  has  been  to  cover  in  this  way  the 
common  ailments  and  troubles  of  early  childhood,  and  they 
hope  that,  all  in  all,  the  volume  may  be  found  an  instruc- 
tive and  safe  guide  for  mothers  in  the  care  of  children  both 
in  health  and  in  illness. 


CONTENTS 


PART  I 


THE  GENERAL  CARE  OF  CHILDREN 

PAGE 

I  The  Preparation  for  Motherhood 3 

Diet — Dress  —  Exercise  and  Clothing — Discomforts  —  Care  of 
the  Breasts — The  Monthly  Nurse  —  Time  of  Confinement — 
The  Outfit  of   the    Lying-in    Chamber  —  The   Baby  Basket 

—  Preparations  for  the  Bath  —  Precautions  for  the  Mo- 
ther—  The  Value  of  a  Cheerful  Frame  of  Mind. 

II  The  Nursery 18 

Light  and  Air  —  Ventilation  and  Heating  —  The  Proper  Tem- 
perature —  Lights  —  Nursery  Furnishings. 

III  The  New  Baby 25 

Baby's  First  Bath  —  Special  Precautions — The  Navel-String. 

IV  Nursery  Routine 30 

Hours  of  Sleep — Disturbed  Sleep  —  Suckling  —  Crying — Un- 
successful Suckling  —  The  Mother's  Diet  —  Bathing. 

V  Baby's  Airing  and  Exercise 40 

The  Baby-Carriage  —  Exercise  for  Older  Children. 

VI  Dress  and  Clothing 44 

The  Principal  Requirements  in  Dress—  The  Napkins  —  Socks 

—  Old-Fashioned  Clothing— The  "Gertrude"  Suit  — Night 
Dress  —  Shoes  —  Fashion  in  Dress  —  Stocking  Supporters  and 
Drawers  —  Garments  for  Older  Children. 

VII  Growth  and  Development 59 

Gain  in  Weight  — Gain  in  Height  —  Muscular  Development  — 
The  Special  Senses  — Speech  — The  Teeth— Teething  — Sat- 
isfactory Growth  —  Outgrowing  Defects  —  Phimosis  —  Condi- 
tions of  Proper  Development. 
ix 


X  CONTENTS 

PAGE 

VIII  Food  and  Feeding 77 

Breast  Milk  —  Artificial  Feeding  —  Cow's  Milk — Purity  of  the 
Milk  Supply— The  Constituents  of  Milk  — Modified  Milk 
—  Varying  Proportions  in  Feeding  —  Bottles,  Nipples,  and 
Measures  —  The  Separation  of  Cream  —  Various  Mixtures  — 
Feeding  Conveniences  —  Sterilization  —  Gruels  —  Broths  and 
Meat  Juice  —  The  Second  Year  —  The  Feeding  of  Older 
Children  —  Digestibility  of  Food— The  Chewing  Teeth  — 
Meat  and  Eggs  —  Zwieback  and  Crackers  —  Gruels  and  Por- 
ridges — Fruits  —  Potatoes  —  The  Five  Meals  —  Feeding  After 
the  Second  Year  —  General  Rules  for  Diet  —  The  Third  Year 
and  Thereafter— ''Animal  Foods "  — The  Value  of  Eggs  — 
Various  Meats  —  Fish  as  Food  —  Soups  — Vegetables  — Bread 
and  Cereals  —  Macaroni  —  Desserts  —  Fruit  —  Water  and 
Other  Drinks —  Objections  to  Sweets. 

IX  Disorders  Associated  with  Improper  Feeding 124 

Symptoms  of  Rickets — Changes  Due  to  Rickets  —  Causes 
and  Cure  of  Rickets  —  Infantile  Scurvy  —  Causes  and  Cure  of 
Scurvy  —  Habitual  Constipation  —  Hygienic  Treatment  of 
Constipation  —  Massage  —  Suppositories  —  Enemata  and  Lax- 
ative Medicines  —  Varieties  of  Diarrhoea  —  Rules  for  all  Cases 
of  Diarrhoea —  Stomach  Indigestion  and  Colic. 

X  The  Evidences  of  Illness 136 

General  Behavior —  The  Head,  Face,  and  Eyes  —  Signs  About 
the  Mouth  — Throat  Troubles  — The  Voice  — The  Ears  — 
Breathing  —  Various  Coughs  —  Vomiting  —  The  Urine  and 
Bowel  Discharges  —  Fevers  —  Symptoms  of  Contagious  Dis- 
eases —  The  Invasion  Period  —  Characteristic  Eruptions  — 
Periods  of  Isolation. 

XI  Domestic  Treatment  of  Illness 149 

Precautionary  Measures  —  The  Warm  Bath  —  Medicated 
Baths  —  How  to  Give  Baths  —  Sponge-Baths  —  Vapor-Baths — 
Cold  Compresses  —  Hot  Applications  —  Poultices  —  How  to 
Apply  Poultices  —  Jackets  for  the  Chest  —  Cathartics  —  Calo- 
mel —  The  Giving  of  an  Enema. 

XII  Hints  Regarding  the  Administration  of  Medicines . .  .162 

Liquid  Medicines  —  Ways  of  Giving  Medicines  —  How  to  Pre- 
pare a  Dose  —  Iron  Preparations —  Castor-Oil  — Medicines  in 
Solid  Form  —  Swallowing  Made  Easy  —  Rules  for  the  Sick- 
Room. 


CONTENTS  xi 

PAGE 

XIII  Nursery  Emergencies 169 

Domestic  Surgery  —  Ragged  Wounds  —  The  Cleansing  of 
Punctured  Wounds  —  Bruises  and  Bumps  —  Sprains  —  Burns 
and  Scalds  —  Cautions  as  to  Fire  —  Frost-Bite  and  Chilblains 
—  Removal  of  Foreign  Bodies  —  Nosebleed  —  Resuscitation 
in  Drowning  Accidents  —  Convulsions  —  Accidents  Due  to 
Poison. 

XIV  The  Household  Pharmacy 182 

Conveniences  —  For  Surgical  Needs  —  Disinfectants  —  Medi- 
cines —  Emetics  —  Carminatives  —  Remedies  for  Fever  — . 
Bromides  —  Opium  Preparations  —  Various  Antidotes. 


PART  II 

QUESTIONS  AND  ANSWERS 
I  Minor  Ailments  and  Troubles 193 

The  Causes  and  Treatment  of  Colic  —  Colic  and  Teething  — 
Colic  Accompanying  Nursing — ''Three-Months'  Colic"  — 
Cure  for  Cold  Hands  —  Cold  Feet  as  a  Consequence  of  Short 
Clothes  —  Perspiring  Feet  —  Enlargement  of  Glands  —  Prob- 
able Cause  of  Mouth-Breathing  —  Enlarged  Uvula  —  Patches 
on  the  Tongue  —  Coated  Tongue  —  The  Prevalence  of  "  Sore 
Mouth  "  —  The  Causes  of  Sore  Mouth  —  Swollen  Tonsils  — 
Roughness  of  the  Voice  —  Bed-Wetting  —  Bed-Wetting  in  a 
Nervous  Child  —  The  Cause  and  Cure  of  Hiccough  —  Exces- 
sive Nosebleeding  —  Gritting  the  Teeth  as  a  Symptom  of 
Worms  —  The  Signs  of  Worms  —  The  Cause  of  Pin- Worms  — 
Treatment  for  Pin- Worms  —  Persistent  Itching  of  the  Nose  — 
What  to  do  for  an  Attack  of  False  Croup  —  The  Treatment  of 
Bumps  —  Drowsiness  Following  a  Bump  on  the  Head  — 
Fainting  —  Cracked  Lips  and  Chapped  Skin. 

[I  Defects  and  Blemishes 219 

Freckles  —  A  Mark  on  Baby's  Face  —  The  Removal  of  a  Birth- 
Mark  —  Waits  —  The  Beginning  and  Treatment  of  Stammer- 
ing —  Lisping  —  Want  of  Symmetry  in  the  Formation  of  the 
Head  —  Umbilical  Growth—  Round  Shoulders  —  Fear  of  Bow- 
Legs  —  Remedies  for  Bow-Legs  —  A  Confirmed  Habit  of 
Stumbling  —  A  Tongue-Tied  Baby  —  Cleft  Palate  and  Harelip 
—  '*  Whopper-Jaw"  —Deaf-Mutism. 


xii  CONTENTS 

PAGE 

III  Colds  and  Catarrh 233 

Fresh  Air  and  Colds  —  Comprehensive  Questions  Concerning 
Coughs  and  Colds  —  Treatment  of  a  ''  Hard  Cold  "  —  Causes 
and  Treatment  of  Catarrh  —  The  Communicability  of  Catarrh 

—  Care  of  a  Sensitive  Throat  —  Taking  Cold  Easily  —  Cold  in 
the  Head ;  Application  of  Vaseline  —  "  Starving  a  Cold." 

IV  Whooping-Cough 243 

The  First  Symptoms  of  Whooping-Cough  —  Supposed  Igno- 
rance of  Physicians  Concerning  Whooping-Cough  — Contagion 
of  Whooping-Cough — Severity  of  Whooping-Cough  in  Rela- 
tion to  Age. 

V  Difficulties  of  Walking  and  Disorders  of  the  Limbs  247 

The  Possible  Dangers  from  Early  Walking  —  Possibly  Over- 
burdened Limbs  —  Turning-in  of  the  Toes  —  Disinclination  to 
Put  the  Foot  Down  —  Weak  Limbs  —  The  Significance  of  a 
Limp  —  Pott's  Disease  —  Knock-Knee  —  Weak  Ankles. 

VI  Constipation 253 

Constipation  in  both  Mother  and  Child ;  Laxative  Diet ;  The 
Action  of  Senna  —  Magnesia  as  a  Laxative  —  Constipation  in 
a ''Bottle  Baby"  —  Castile-Soap  Suppositories;  Candy  Sup- 
positories —  Objections  to  Suppositories  ;  The  Effect  of  Mas- 
sage ;  The  Value  of  Regular  Habits  —  The  Effect  of  an  Enema. 

VII  Various  Digestive  Disturbances 258 

A  Probable  Case  of  "  Dyspepsia  "  —  Habitually  Coated  Tongue 

—  Excessive  Perspiration  of  the  Head  and  Other  Signs  of 
Rickets  —  The  Uses  of  Bicarbonate  and  Phosphate  of  Soda 
for  Weak  Digestion  —  ''Liver  Troubles" — Domestic  Treat- 
ment of  Summer  Complaint  —  Apparent  Overfeeding  —  Indi- 
gestion; Dilution  of  Milk  Called  for  —  Paregoric  for  Green 
Movements  —  The  Causes  of  Dirt -Eating. 

VIII  Eruptions  266 

The  Characteristics  of  Mild  and  of  Serious  Eruptions  —  "  Driv- 
ing In"  Eczema  —  Heat-Rash  —  Red-Gum  —  Psoriasis — Se- 
borrhoea  —  Ringworm  —  Herpes  and  its  Cure  —  ''  Black- 
Heads  " —  The  Cause  and  Cure  of  Hives. 

IX  Common  Diseases 277 

Precautions  in  a  Case  of  Diphtheria  —  General  Experiences 
with  Antitoxin — Antitoxin  as  a  Preventive  and  Cure  —  Ques- 
tions as  to  Diphtheria  and  Membranous  Croup  ;  Popular  Mis- 
conception  of   Medical   Terms  —  Croup  —  Characteristics  of 


CONTENTS  xiu 

PAGE 

Malarial  Disorders  —  Remedies  for  Malarial  Fever  — The 
Causes  arid  Treatment  of  Typhoid  Fever  —  Symptoms  of 
Typhoid  Fever  — The  Usual  Symptoms  and  Treatment  of 
Scarlet  Fever  —  Characteristics  of  Measles  —  German  Measles 
or  Rotheln — The  Causes  and  Characteristics  of  Rheumatism 

—  The  Contagiousness  of  Mumps  —  The  Value  of  Gargling  in 
Sore  Throat ;  Different  Kinds  of  Sore  Throat  —  St.  Vitus's 
Dance- Signs  of  Heart  Trouble  —  Alcoholic  Stimulants  in 
Fevers— The  Value  of  Cod-Liver  Oil  in  Cases  of  Scrofula  — 
A  Case  of  Tape- Worm  in  a  Four-year-old  Child  —  The  Causes 
of  Meningitis  —  Jaundice  ;  Biliousness  —  Hydrocephalus,  or 
Water  on  the  Brain  —  The  Characteristics  of  Hernia  — The 
Causes  of  Rupture  —  Treatment  of  Hernia  —  Treatment  of  a 
Protruding  Navel  —  Falling  of  the  Bowel. 

X  Harmful  Habits 302 

Thumb-Sucking  —  Objections  to  ' '  Baby's  Comforter  "  —  Hold- 
ing the  Breath  —  Nail-Biting  and  Its  Cure  —  The  Chewing- 
Gum  Habit  in  Children  —  Lip-Sucking. 

XI  Phases  of  Development 307 

The  Infant's  Normal  Weight  —  Measurements  and  Weights  of 
Boys  and  Girls  at  Various  Ages  —  When  Childreu  First  Begin 
to  See  —  Development  of  the  Saliva  and  Tear-Glands  —  The 
Development  of  Speech  —  Imperfect  Nutrition  and  its  Causes 

—  Drooping  Shoulders  —  Left-Handedness. 

XII  Weaning 313 

Systematic  Weaning — Dropping  the  Night  Meal  —  Nursing 
During  Pregnancy. 

XIII  Sleeping 316 

The  Hammock  as  a  Sleep-Inducer  —  Putting  a  Baby  to  Sleep 
with  the  Rubber  Nipple  ;  **  Magic  "  Effects  of  Sugar-Rags  — 
Experimenting  with  Anodynes  —  A  Night-Light  in  the  Nur- 
sery—  The  Value  of  the  Pillow  in  Sleeping  —  The  Most  Com- 
fortable Pillow — The  Fir-Pillow  —  Objections  to  Having 
Children  Sleep  With  Adults  —  Position  for  Sleep  —  Sleeping 
on  the  Stomach  —  The  Causes  of  Night  Terror  —  Worms  as 
Possible  Causes  of  Talking  in  Sleep. 

XIV  Bathing 324 

A  Bath  at  Night  —  The  Effects  of  Cold  and  Warm  Baths  — 
Soap  —  Diminishing  the  Frequency  of  Baths  —  The  Outing 
After  a  Bath. 

XV  Teething 328 

Is  Normal  Teething  Painless  ?  — Late  Teething — Drooling. 


xiv  CONTENTS 

PAGE 

XVI  The  Teeth 333 

Strengthening  the  Teeth  —  Effect  of  Early  Feeding  Upon  the 
Teeth ;  the  Use  of  the  Tooth-Brush  —Early  Decay  of  Teeth  — 
Discoloration  of  the  Teeth  —  Peculiarity  of  Teeth — Removing 
Redundant  or  "Extra"  Teeth— The  Filling  of  the  First 
Teeth  —  Unusual  Absence  of  Upper  Incisors. 

XVII  The  Eyes 339 

Squint  —  Test  for  Cross-Eyes  —  Needless  Anxiety  about  Bril- 
liant Eyes —  Eye-Pupils  of  Different  Sizes  —  Sties  — Clipping 
the  Eyelashes — A  "  Weeping"  Eye  —  Eye-Strain  as  a  Cause 
of  Headache  —  Pink-Eye  —  Granular  Eyelids  —  Astigmatism. 

XVIII  The  Ears 346 

Earache  —  Partial  Deafness  —  Prominent  Ears  —  Tampering 
with  Large  Ears  —  Hardening  of  Ear-Wax  —  Cause  and  Pre- 
vention of  Ear  Trouble  —  Significance  of  a  Running  Ear. 

XIX  The  Hair  and  Scalp 351 

strengthening  Thin  Hair  —  Washing  the  Scalp  —  The  Use  of 
Soap  on  the  Head  —  Tampering  with  the  Color  of  the  Hair  — 
Milk-Crust  —  The  Belief  that  Long  Hair  is  Weakening. 

XX  The  Feet 355 

Incipient  Corns  —  Distorted  Feet —  Ingrowing  Nails. 

XXI  Hygiene  and  Sanitation 359 

The  Objections  to  Vaccination  ;  Supposed  Failure  of  Vaccina- 
tion to  Protect ;  the  Proper  Age  for  Vaccination  —  The  Dis- 
advantage of  Postponing  Vaccination — The  Desirability  of 
Keeping  Water  on  the  Stove  —  Plants  in  the  Bedroom  — 
Proper  and  Improper  Filters — Sulphur  for  Disinfection— Disin- 
fectants— Ground  Air  from  Excavations;  Quinine  as  a  Preven- 
tive of  Fever  and  Ague  —  Temperature  of  the  Nursery  and  the 
Bedroom — The  Gas-Stove  in  the  Nursery — How  Longdo  Diph- 
theria Germs  Linger  ?  —  Danger  of  Typhoid  Fever  to  Babies 
from  Impure  Drinking- Water — Susceptibility  to  Second  At- 
tacks of  Disease  —  Physical  Exercise  for  Girls — Disinfecting 
Paper  Money  from  a  Sick-Room — Baby  Powder  —  The  Value 
of  Water  in  Rheumatism  —  The  Treatment  of  Nervous  Chil- 
dren—  The  Hardening  Theory  —  Hardening  in  Practice  — 
Rational  and  Injurious  School-Work;  the  School  Lunch  — 
Over-Study  as  a  Cause  of  Chorea. 

XXII  Questions  of  Dress 376 

The  Knitted  Band ;  Getting  Rid  of  the  Pinning-Blanket  — 
Seasonable  Dress  for  a  Five-Months-Old;  Silk  or  Flannel?  — 
Night  Coverings —  The  Nightcap ;  Stockings  at  Night  — Sum- 


CONTENTS  XV 

PAGE 

mer  Dress  —  Summer  Night-Clothing  —  Clothing  for  Winter  — 
The  Value  of  Long  Stockings  —  Stiff  Soles  for  Babies  —  Gar- 
ters and  Stocking-Supporters —  Proper  Stockings  and  Shoes 
for  a  Depressed  Toe  —  The  Advisability  of  Going  Barefoot. 

XXIII  Care  of  the  Mother 385 

Nervousness  in  the  Mother  as  a  Cause  of  Baby's  Colic  —  A 
Sensitive  Breast  —  Sore  Nipples  —  The  Diet  of  a  Nursing 
Mother —  The  Best  Method  of  Drying  up  the  Mother's  Milk  — 
"  Nursing  Sore  Mouth  "  —  Excess  of  Abdominal  Fat  —  Falling 
Out  of  the  Hair  after  Confinement. 

XXIV  Special  Requirements  and  Perplexing  Points  in  the 

Nursery  Routine  394 

Crying  and  Sedatives  —  Hard  Crying  as  a  Cause  of  Rupture  — 
Rocking  the  Baby  —  Age  for  Sitting  up  in  the  Chair  —  Baby  in 
the  Corner  — Playing  on  the  Floor —  The  Effects  of  "  Jostling 
About" — Rapid  Carriage-Driving  for  Very  Young  Children  — 
Methods  of  Lifting  the  Baby  — Objections  to  a  Veil  —  Teach- 
ing the  Use  of  the  Nursery  Chair —  The  Care  of  Finger-Nails — 
Supposed  Advantages  of  Being  the  "  Middle  Child"  —  Unjus- 
tified Fear  of  Consumption  —  The  Definition  of  Nervousness 
— Washing  the  Infant's  Mouth  —  The  Giving  of  an  Enema  — 
The  Mustard-Plaster — Kissing  by  Force. 

XXV  Feeding  Problems 408 

The  Selection  of  a  Wet-Nurse — Can  the  Nurse's  or  Mother^s 
Milk  be  Poisonous  ?  —  The  Flow  of  Milk  the  First  Days  after 
Delivery  —  Goat's  Milk  and  Ass's  Milk  —  Testing  the  Quality 
of  Breast  Milk  —  Objections  to  Giving  Breast  Milk  by  Spoon  — 
Bottle  versus  Spoon  —  '^Sucking  Wind" — Combined  Nursing 
and  Bottle-Feeding  at  One  Meal  —  The  Signs  of  Insufficient 
Breast  Milk — Nursing  Another  Baby  in  Addition  to  One's 
Own  —  The  Supply  of  Breast  Milk  as  Compared  with  the 
Allowance  of  Bottle-Fed  Babies  — Evils  of  Early  Mixed  Feed- 
ing ;  Effect  of  the  Mother^s  Diet  Upon  the  Child's  Teething  — 
Feeding  at  Night  after  Weaning  —  The  Tests  of  Rich  Milk  — 
Scum  on  Boiled  Milk  —  A  Warning  against  Sour  Milk  —  Dan- 
gers from  Impure  Milk ;  When  Sterilization  is  Necessary  — 
Keeping  Sterilized  Milk  in  Summer  —  Does  Sterilized  Milk 
Constipate  ?  —  Injurious  Quality  of  Lime-Water —  Food  versus 
Sleep  —  The  Preparation  of  Barley- Water  ;  Advisability  of 
Sterilization  ;  Quantity  of  Milk  and  Barley- Water  for  a  One- 
Year-Old —  The  Value  of  Barley  and  Oatmeal  Gruel  —  Harm- 
fulness  of  New  Bread  and  Cookies —  The  Relative  Merits  of 
Graham  and  White  Bread  —  Balls   from    Graham    Flour  — 


CONTENTS 

Graham,  Oatmeal,  and  the  Various  Prepared  Cereals — Honey 
and  Molasses  —  Pop-Corn  —  Oatmeal  Gruel  as  a  Laxative  — 
Is  Oatmeal  ' '  Heating  "  ?  —  Incompatibility  of  Fruit  and  Milk — 
Strawberries  at  Four  Years  —  Smuggling  Milk  into  the  Bill 
of  Fare  —  Bananas,  Apples,  and  Oranges  —  The  Uses  of  Sage- 
Tea— The  Abuse  of  Sugar  — Breaking  the  "Bottle  Habit"— 
Teaching  Baby  to  Eat ;  the  Need  of  Water  to  Quench  Thirst 
—  Pure  versus  Diluted  Milk  at  Two  and  a  Half  Years  —  But- 
termilk as  Food  for  Children  —  Ice-Cream  —  Inordinate  Fond- 
ness for  Salt  —  Why  Frozen  Cream  is  Unsuitable  Food — Uses 
of  Fat  in  Foods  — Variety  in  Food  — The  Effect  of  Tea  on 
Children  —  Cocoa  —  Feeding  a  Premature  Child  —  Butter  and 
Eggs  for  a  Child  of  Delicate  Digestion  —  Proper  Dilution  of 
Condensed  Milk  —  A  "  Hard-Reared  "  Baby  —  Probable  Over- 
Feeding  ;  Frequent  Changes  of  Food  ;  Excessive  Vomiting  — 
Suggestions  for  Improving  the  Dietary  in  a  Case  of  Slow  Teeth- 
ing— Loss  of  Appetite;  Imperfect  Nutrition — Distaste  for 
Meat. 


PART  I 
THE  GENERAL  CARE  OF   CHILDREN 


THE  CENTURY  BOOK 
FOR  MOTHERS 


THE  PREPARATION  FOR  MOTHERHOOD 

IN  one  sense,  the  care  of  a  child  begins  with  its  concep- 
tion. But  the  ante-natal  care  cannot  be  given  directly 
to  the  unborn ;  it  must  be  bestowed  upon  the  mother.  What- 
ever she  would  do  for  its  welfare  must  be  performed  through 
judicious  care  of  her  own  health.  Let  it  be  understood  at 
once  that  there  is  no  special  or  patent  regimen  to  be  fol- 
lowed during  pregnancy.  Success  attends  the  careful  and 
common-sense  application  of  the  ordinary  rules  of  health  to 
the  changed  conditions  that  come  with  pregnancy.  Just  in 
proportion  as  the  mother  has  previously  led  a  hygienic  life 
will  the  task  be  an  easy  one.  If  she  has  lived  in  neglect 
or  defiance  of  hygiene,  then  she  must ' '  cease  to  do  evil,  learn 
to  do  well.'' 

DIET 

The  diet  of  pregnancy  should  be  simple  and  nutritious, 
but  should  not,  unless  by  reason  of  some  special  disorder,  be 
different  from  the  wholesome  diet  of  a  non-pregnant  woman. 
The  special  restricted  dietaries  vaunted  to  insure  easy  de- 
livery have  no  such  effect,  and  if  the  results  claimed  were 
really  attained  they  would  be  merely  a  saving  of  some  pain 
on  the  part  of  the  mother  at  the  expense  of  her  infant's  de- 
velopment.    As  there  is  a  tendency  to  nausea,  flatulence,  and 

3 


4         THE  CENTURY  BOOK  FOR  MOTHERS 

acidity  with  resulting  heartburn,  the  diet  should  be  not  only 
nutritious  but  easily  digestible.  While  the  derangements 
just  mentioned  are  most  likely  of  nervous  origin,  there  is 
no  doubt  that  the  digestive  power  is  usually  to  some  degree 
impaired.  The  use,  therefore,  of  foods,  such  as  sweets,  pas- 
try, and  rich  articles  generally,  which  are  particularly  likely 
to  produce  fermentation  in  any  state  of  health,  must  tend 
to  aggravate  these  unpleasant  symptoms. 

There  is  a  tendency  during  pregnancy  to  constipation, 
chiefly  from  mechanical  pressure  of  the  growing  womb,  or 
to  the  exaggeration  of  such  a  tendency  if  it  already  exists. 
To  some  degree  this  may  be  combated  by  the  use  of  foods 
of  a  laxative  tendency — fruits,  coarse  cereals,  and  all  the 
usual  articles  employed  with  this  intent.  In  the  latter  part 
of  pregnancy,  when  the  pressure  of  the  womb  upon  the  other 
abdominal  organs  becomes  considerable,  it  is  usually  wise  to 
moderate  the  amount  of  flesh  diet,  if  it  has  been  consider- 
able, and  to  supply  its  place  with  milk  and  eggs,  in  order 
that  the  tax  upon  the  kidneys  may  be  lessened.  The  free 
use  of  liquids— that  is  to  say,  of  water  or  thin  nutriment- 
is  valuable,  both  as  further  helping  the  work  of  the  kidneys 
and  as  favoring  the  proper  action  of  the  bowels. 

DRESS 

The  dress  of  the  pregnant  woman  must  be  entirely  free 
from  constriction.  Very  early  in  gestation  the  corset  would 
better  be  abandoned,  or,  if  worn  at  all,  so  loOv«ely  laced  as 
to  make  no  pressure.  All  of  the  organs,  lungs,  heart,  stomach, 
bowels,  not  to  mention  the  womb  itself,  demand  the  greatest 
freedom.  There  is  a  new  and  increased  demand  for  oxy- 
gen: the  lungs  must  take  in  more  air,  the  heart  and  blood- 
vessels must  convey  a  more  unrestricted  supply  of  the  better 
oxygenated  blood.  All  other  sources  of  constriction,  such 
as  tight  garments  and  bands,  must  be  avoided.  The  garter 
deserves  special  mention,  as  in  pregnancy  there  is  a  ten- 
dency to  swelling  of  the  veins  of  the  lower  extremities,  and 


THE  PREPARATION  FOR  MOTHERHOOD        5 

this  is  aggravated  by  a  tight  garter.  Some  other  form  of 
stocking  support  is  preferable  when  the  hose  must  be  kept 
trimly  in  position. 

EXERCISE   AND   CLOTHING 

Air  and  exercise  conduce  to  well-being  in  pregnancy  as  at 
other  times.  The  amount  of  exercise  that  can  be  taken  will 
vary  very  much  with  cases.  The  woman  who  does  her  own 
housework  or  any  considerable  part  of  it  will  not  need  exer- 
cise, for  instance,  but  will  need  open  air.  A  woman  trou- 
bled badly  with  "morning  sickness"  may  be  unable  for  the 
time  being  to  take  outdoor  exercise  at  all,  but  to  her,  as  to 
all,  air  and  sunshine  will  be  beneficial,  and  it  should  be  had 
if  possible,  even  if  it  be  no  more  than  what  can  be  got  in 
the  invalid's  bedroom.  Assuming  that  the  woman  is  able 
to  take  exercise,  how  much  shall  she  take?  It  must  stop 
short  of  serious  fatigue,  and  it  must  never  be  violent,  lest, 
especially  in  those  with  a  tendency  in  that  direction,  it  favor 
or  excite  miscarriage.  In  a  general  way,  exercise  which 
gives  a  feeling  of  well-being  and  of  only  gentle  weariness 
is  beneficial  and  aids  sleep. 

The  customary  use  of  the  bath  need  not  ordinarily  be  in- 
terrupted. It  aids  the  functions  of  the  skin,  and  is  still 
another  mode  of  assisting  the  kidneys  in  their  functions. 
The  action  of  the  skin  may  be  further  assisted  by  suffi- 
ciently wai-m,  but  not  burdensome,  clothing,  and  the  lower 
limbs  especially  need  protection  from  chilling  when  the  pro- 
tuberant abdomen  prevents  the  usual  clinging  of  the  gar- 
ments about  the  person.  Then  the  warmth  of  the  garments 
next  the  skin  should  be  increased.  Many  women  dislike 
warm  under-drawers,  but  their  use  at  this  time,  if  the 
weather  be  cold,  is  very  desirable. 

DISCOMFORTS 

It  is  not  easy  to  say  at  just  what  point  the  disturbances  of 
functions  usual  in  pregnancy  cease  to  be  normal  and  become 


6  THE  CENTURY  BOOK  FOR  MOTHERS 

disorders  to  be  dealt  with.  Thus,  a  certain  amount  of 
''morning  sickness"  is  so  common  as  to  be  considered  nor- 
mal, but  this  symptom  may  become  so  severe  as  to  be  dan- 
gerous. Whenever  any  of  the  ordinary  functional  disorders 
of  pregnancy  become  really  troublesome  they  are  the  proper 
care  of  the  physician.  Short  of  this  point,  it  is  desirable 
that  the  expectant  mother  should  keep  up  a  certain  obser- 
vation of  her  own  symptoms,  without  allowing  herself  to 
'  become  at  all  hypochondriacal  concerning  them.  Too  much 
self-consideration  is  always  harmful ;  too  little  may  occasion- 
ally be  disadvantageous.  In  this  spirit  we  may  consider 
what  may  be  done  by  domestic  practice  for  some  of  the  com- 
monest ailments  of  pregnancy. 

Nausea  and  vomiting,  popularly  called  ''morning  sick- 
ness," because  of  their  usual  occurrence  at  that  time  of  day, 
are,  as  has  just  been  said,  almost  always  present  at  some  time 
of  pregnancy,  especially  in  the  earlier  months.  Sometimes 
salivation  is  associated  with  them  or  takes  their  place.  Ordi- 
narily their  severity  is  not  so  great  as  to  demand  the  inter- 
ference of  the  physician,  although  they  may  sometimes  tax 
his  resources  to  the  utmost.  In  the  simpler  cases  the  dis- 
comforts can  be  mitigated  until  the  symptoms  disappear,  as 
they  commonly  do  after  the  first  three  months,  by  attention 
to  all  the  details  of  hygiene  already  suggested,  and  espe- 
cially those  of  feeding  and  rest.  Thus,  food  should  be  given 
in  small  quantities  at  a  time  and  proportionately  often; 
easily  digested  forms  of  food,  such  as  milk  with  lime-water 
or  with  effervescing  waters,  nutritious  soups  or  meat  ex- 
tracts, and  the  like,  being  chosen  if  the  nausea  is  severe  or 
persistent.  Many  patients,  if  they  can  remain  absolutely 
quiet  in  bed  until  the  middle  of  the  forenoon,  are  able  to 
pass  the  remainder  of  the  day  in  comfort  at  their  usual 
occupations.  If  the  symptoms  are  more  severe  it  may  be 
necessary  to  keep  the  bed  continuously  for  some  time. 

Another  sjrmptom  referred  to  the  stomach  is  heart-burn, 
generally  due  to  acidity.  This  is  more  persistent  than  nau- 
sea usually  is,  and  is  perhaps  more  severe  in  the  later  months. 


THE  PREPARATION  FOR  MOTHERHOOD        7 

It  is  best  met  by  antacids— that  is  to  say,  alkalis.  Those 
most  used  are  the  familiar  cubes  of  magnesium  carbonate 
or  other  magnesia  preparations,  lime-water,  sodium  bicar- 
bonate, or  the  aromatic  spirits  of  ammonia,  both  of  the  latter 
being  dissolved  in  water  when  administered. 

The  flatulence  of  pregnancy  is  best  met  by  insuring  regu- 
larity of  the  bowels  and  by  correcting  disordered  conditions 
of  the  stomach. 

Constipation  is  to  be  combated  by  the  same  means  as  in 
the  non-pregnant  condition— namely,  by  mild  laxatives,  sup- 
positories, or  enemata,  in  addition  to  the  dietetic  helps  al- 
ready alluded  to. 

Swollen  veins  in  the  lower  limbs  are  common.  If  not  very 
severe  they  can  be  held  in  check  by  regulating  the  bowels 
and  the  wearing  of  some  kind  of  elastic  stocking  if  neces- 
sary. The  avoiding  of  unnecessary  standing  when  the  pa- 
tient is  not  walking  is  useful,  as  is  also  the  raising  of  the 
limbs  whenever  practicable.  Similar  care  is  advantageous 
to  relieve  effects  of  pressure  elsewhere,  as,  for  instance,  upon 
the  bladder,  as  evidenced  by  frequent  calls  to  pass  water. 

CARE   OF  THE   BREASTS 

As  pregnancy  proceeds,  progressive  changes  occur  in  the 
breasts  and  nipples.  In  many,  perhaps  most,  cases  no  care 
is  needed  beyond  the  avoidance  of  pressure  upon  the  parts, 
which  is  insured  by  ampleness  of  the  garments  covering 
them.  Occasionally  the  nipples  are  so  diminutive  as  to 
make  it  probable  that  the  infant  will  have  difficulty  in  seiz- 
ing them.  In  such  cases  it  seems  advantageous  that  the 
mother  should  gently  draw  or  coax  out  the  nipples  with  the 
fingers  morning  and  evening  during  the  later  months  of 
pregnancy.  When  the  surface  of  the  nipples  is  very  tender 
and  shows  a  tendency  to  crack  or  to  become  excoriated,  it 
may  usually  be  hardened  by  a  daily  application  of  some 
astringent.  Among  those  commonly  used  are  tannin  and 
glycerin,  twenty  grains  of  the  former  to  an  ounce  of  the 


8         THE  CENTURY  BOOK  FOR  MOTHERS 

latter;  alcohol  and  water,  equal  parts,  with  a  little  alum 
added;  tincture  of  myrrh  and  the  familiar  preparations  of 
wdtch-hazel.  They  should  be  applied  with  the  finger  or  a 
soft  camel's  hair  pencil.  The  nipples  should  be  cleansed 
carefully  with  a  bland  soap,  such  as  Castile,  and  warm  water, 
and  care  should  be  taken  to  dry  them  very  thoroughly  before 
each  application. 

THE   MONTHLY   NURSE 

One  of  the  duties  of  the  expectant  mother,  unless  some 
friend  relieves  her  of  the  task,  is  the  selecting  of  a  monthly 
nurse.  The  choice  may  be,  in  small  places,  a  very  limited 
one,  and  the  selection  practically  forced.  But  in  most  large 
towns  at  the  present  time,  since  nursing  has  become  a  rec- 
ognized profession,  quite  a  number  of  nurses  are  usually 
available.  Two  elements  have  to  be  considered  in  the  nurse 
—her  professional  capability  and  her  acceptability.  Per- 
haps more  often  than  not,  the  physician  is  not  consulted 
as  to  the  selection.  The  opinion  of  female  friends  as  to  the 
nurse's  acceptability  determines  the  question.  And  if  the 
nurse  selected  is  one  who  has  graduated  from  a  good  train- 
ing-school, this  method  of  selection  is  probably  as  good  as 
any  for  ordinary  cases.  The  physician  might  err  upon  the 
other  side  by  considering  only  the  nurse's  skill.  The  writer, 
when  he  is  asked  concerning  a  nurse,  usually  considers  the 
circumstances  of  the  household  as  well  as  the  medical  aspects 
of  the  case,  and  submits  the  names  of  several  nurses  likely 
to  be  suitable.  The  patient  can  then  select  that  one  most 
attractive  to  herself.  The  physician  can  generally  learn 
pretty  accurately  the  professional  qualifications  of  the  nurse. 
The  elements  that  go  to  make  up  acceptability,  which  the 
physician  may  be  acquainted  with  or  which  the  patient  or 
her  friends  may  be  able  to  learn  about,  are  her  diligence,  her 
disposition  and  adaptability.  Thus,  a  nurse  may  be  entirely 
competent,  but  lazy,  in  which  case  details  may  not  be  prop- 
erly attended  to.  On  the  other  hand— although  this  is  a 
lesser  evil— she  may  be  something  of  a  martinet,  and  attend 


THE  PREPARATION  FOR  MOTHERHOOD        9 

to  her  duties  with  a  strictness  which  is  tiresome  and  per- 
haps unnecessary.  Her  disposition  tells  in  the  ease  with 
which  she  puts  up  with  the  necessary  annoyances— and  they 
are  many— of  the  confinement  chamber,  and  the  tact  with 
which  she  gets  on  with  the  servants,  so  that  they  cheerfully 
do  the  extra  work  put  upon  them.  In  the  same  way  her 
general  adaptability  counts.  Some  nurses  are  excellent 
when  all  the  resources  of  a  wealthy  family  are  at  command, 
but  are  useless  in  cramped  quarters.  The  tactful  nurse  fits 
in  anywhere,  in  the  luxurious  mansion  or  the  narrow  apart- 
ment, and  gives  satisfaction  above  stairs  and  below  stairs 
alike ;  and  if  she  departs  with  the  cook 's  good-will  she  may  be 
accounted  to  have  earned  her  blue  ribbon.  The  greatest 
tax  upon  her  tact  will  be  the  excluding,  without  giving 
offense,  of  obtrusive  visitors,  whose  presence  and  conversa- 
tion in  the  lying-in  chamber  are  often  harmful  to  the  patient 
and  increase  the  anxiety  of  both  nurse  and  physician. 


TIME   OF   CONFINEMENT 

The  nurse  having  been  selected,  her  first  inquiry  is  likely 
to  be,  ''From  what  date  do  you  wish  to  engage  me?"  This 
opens  the  question  of  the  duration  of  pregnancy.  The  vari- 
ations of  its  duration,  like  those  of  every  natural  process, 
are  well  known  to  medical  men.  Nevertheless,  it  is  equally 
well  known  that  when  the  facts  relating  to  the  probable 
beginning  of  pregnancy  are  accurately  given,  this  variation 
is  in  the  great  majority  of  cases  within  pretty  narrow  limits. 
It  is  indeed  surprising  how  frequently  really  intelligent 
women  are  unable  to  give  the  physician  even  the  date  of  the 
last  period.  This  is  sometimes  due  to  mere  carelessness, 
sometimes  to  the  substitution  of  a  theory  for  a  fact.  Prac- 
tically there  is  but  one  method  of  reckoning— from  the  last 
menstrual  period,  the  first  day  being  used  as  the  most  cer- 
tain. When  reckoning  is  made  from  this  first  day,  the  aver- 
age time  to  delivery  is  forty  weeks,  or  two  hundred  and 
eighty  days,  which  is  just  ten  ordinary  menstrual  intervals. 


10  THE  CENTURY  BOOK  FOR  MOTHERS 

When,  as  occasionally  happens,  a  known  date  of  intercourse 
can  be  reckoned  from,  the  duration  is  about  thirty-nine 
weeks.  It  is  very  desirable,  therefore,  that  the  dates  of  the 
periods  should  be  kept  in  some  sort  of  a  record,  also  that  it 
be  noted  if  there  was  any  variation  of  the  date  or  of  the 
amount  of  flow.  The  reason  for  this  last  suggestion  is  this : 
If  a  pregnancy  begins  immediately  before  a  period  is  due, 
that  period  may  not  be  entirely  prevented.  It  may  be 
tardy,  or,  more  likely,  shortened  very  considerably.  In  such 
cases  the  delivery  would  be  expected,  not  forty  weel^  from 
the  beginning  of  the  period,  but  about  thirty-nine  weeks 
from  a  date  a  little  before  the  period.  If  the  expectant 
mother  has  any  facts  of  this  nature  it  will  be  far  better  to 
let  the  physician  know  them  frankly.  It  is  wise  also  to 
keep  note  of  the  date  when  the  motions  of  the  child  were 
first  perceived,  also  when  they  were  unmistakable,  as  these 
dates  will  help  the  physician  to  check  off  his  calculations, 
especially  in  cases  in  which  there  is  any  uncertainty  by  the 
ordinary  method  of  counting.  Methods  of  ready  reckoning, 
by  tables  or  otherwise,  are  many.  The  best  way,  the  writer 
believes,  is  for  the  patient  to  make  sure  of  the  facts  and 
then  lay  them  before  her  physician,  whose  familiarity  with 
these  reckonings  makes  the  calculation  easy.  He  can  also  dis- 
criminate between  the  dates  which  are  certain  and  those 
which  are  approximate. 

The  date  of  confinement  having  been  settled  as  accurately 
as  possible,  the  expectant  mother  is  able  to  set  the  date 
from  w^hich  she  desires  to  engage  the  nurse.  The  old-fash- 
ioned term  ''monthly  nurse"  expresses  the  period  for  which 
she  is  usually  engaged,  but  if  the  patient's  means  permit 
and  the  nurse  is  acceptable,  it  is  usually  economy  to  keep 
her  longer,  until  the  mother's  strength  is  entirely  restored. 

THE   OUTFIT   OF   THE   LYING-IN  CHAMBER 

It  is  usual,  also,  to  settle  with  the  nurse,  if  the  physician 
has  not  given  the  necessary  directions,  what  outfit  shall  be 


THE  PREPARATION  FOR  MOTHERHOOD       11 

arranged  for  the  lying-in.  It  is  assumed  that  the  lying-in 
chamber  is  the  one  most  wholesome,  airy,  and  sunny  at  com- 
mand, and  that  the  bed  has  a  good,  comfortable  mattress 
upon  it.  It  should  not  be  one  upon  which  a  person  sick 
of  any  communicable  disorder  has  lain,  unless  it  has  been 
thoroughly  disinfected— preferably  it  should  be  one  that  has 
not  been  used  by  any  sick  person  at  all.  The  same  must 
apply  to  the  bedding.  Certain  arrangements  for  protect- 
ing the  bed  during  and  after  delivery  are  necessary.  These 
consist  of  a  rubber  sheet,  over  which  some  absorbent  quilt 
or  pad  is  laid.  The  rubber  should  be  long  enough  to  reach 
across  the  bed,  with  ends  to  fasten.  A  piece  of  rubber  sheet- 
ing three  yards  long  by  two  yards  wide  is  to  be  procured. 
Cut  it  so  that  the  larger  piece  is  two  yards  square;  the 
remainder  is,  of  course,  two  yards  long  and  one  yard  wdde. 
The  pads  are  made  of  some  absorbent  substance— commonly 
absorbent  cotton,  sometimes  wood-pulp— covered  with  a  light, 
porous  fabric,  such  as  cheese-cloth.  Of  these  at  least  three, 
preferably  four,  are  required.  Two  feet  square  is  a  con- 
venient size,  although  the  waiter  prefers  one  rather  larger, 
say  a  yard  square,  for  the  actual  delivery. 

The  nurse  usually  makes  the  bed,  but  in  her  absence  any 
one  can  do  it  properly  by  noting  the  following:  First  pin 
the  larger  rubber  sheet  over  the  mattress,  completely  cover- 
ing the  latter.  Then  put  on  the  bottom  sheet.  Next  put 
the  narrower  rubber  sheet  across  the  middle  of  the  bed  and 
cover  it  with  a  draw-sheet.  On  this  place  one  of  the  pads, 
the  larger  if  there  be  one.  Under  ordinary  circumstances, 
only  a  pad,  or  the  draw-sheet  at  most,  will  be  soiled,  and 
when  these  are  withdrawn  the  patient  will  have  a  perfectly 
dry  and  comfortable  bed  beneath  her. 

In  addition  she  will  need  four  dozen  pads  to  be  used  as 
napkins  to  the  vulva.  They  are  made  of  the  same  material 
as  the  bed-pads,  but  of  appropriate  shape  and  size.  Two 
binders  or  abdominal  bandages  are  to  be  provided.  They 
should  be  long  enough  to  go  one  and  one  third  times  about 
the  hips,  and  wide  enough  to  reach  from  the  lower  margin 


12  THE  CENTURY  BOOK  FOR  MOTHERS 

of  the  ribs  to  the  genitals.  Shaped  binders  are  sometimes 
made,  but  a  skilful  nurse  will  pin  a  straight  strip  of  muslin 
so  that  it  will  fit  the  person  better  than  any  bandage  pre- 
viously modeled  when  the  figure  is  very  different. 

For  the  use  of  the  physician  at  the  time  of  delivery  and 
of  the  nurse  afterward,  quite  a  number  of  articles,  drugs, 
and  surgical  dressings  are  needed.  Those  which  the  physi- 
cian may  need  he  may  have  in  his  obstetrical  bag,  but  in 
cities  most  women  prefer  to  get  them  in  advance,  especially 
the  anesthetics,  so  that  they  are  surely  at  hand  in  case  the 
physician  should  be  so  suddenly  called  that  he  cannot  go 
for  his  bag,  or  for  any  other  reason  should  not  have  the 
desired  articles. 

The  drugs  are  ether  or  chloroform,  or  both,  ergot  in  some 
form,  and  some  good  spirits,  brandy  or  whisky.  The  physi- 
cian will  also  need  some  disinfectants.  Nearly  all  these 
drugs,  being  poison,  can  be  had,  in  some  States  at  least,  only 
on  prescription,  and  it  is  best  to  arrange  with  the  physician 
whether  or  not  the  patient  shall  procure  them,  and,  if  so, 
he  will  give  the  necessary  prescriptions.  The  disinfectants 
needed  are  usually  bichlorid-of-mercury  tablets,  a  bottle 
containing  twenty-five;  carbolic  acid,  the  deliquesced  crys- 
tals, four  ounces ;  boric  acid,  powder  two  ounces  and  crystals 
eight  ounces— the  crystals  are  less  troublesome  to  dissolve, 
as  the  powder  floats;  but  for  some  purposes  the  latter  is 
preferable,  hence  both  are  often  ordered. 

Other  things  usually  ordered  are  the  following :  A  rubber 
douche-bag,  often  called  a  fountain  syringe,  to  hold  three 
quarts;  two  glass  nozzles  for  the  same;  one  square  douche- 
pan  of  agate-ware;  three  basins  of  agate-ware  or  paper,  the 
latter  being  the  lighter;  one  rubber  catheter;  one  glass  ca- 
theter; one  glass  syringe;  one  pound  of  absorbent  cotton 
(also,  to  be  made  of  this  cotton,  two  dozen  mops  to  take  the 
place  of  sponges,  except  for  the  personal  toilet,  for  which 
the  usual  large  and  small  sponges  are  provided)  ;  two  tubes 
of  white  vaseline;  three  papers  of  safety-pins;  ordinary 
pins;  one  cake  of  Castile  soap;  one  skein  of  bobbin,  from 


THE  PREPARATION  FOR  MOTHERHOOD  13 

which,  in  advance  of  need,  the  nurse  will  cut  four  pieces 
ten  or  twelve  inches  long.  Lastly,  a  tube  containing  iodo- 
form gauze  is  often  convenient,  and  so  is  a  sterilized  nail- 
brush in  a  tube,  to  be  used  for  disinfection. 

Some  of  these  things  may  be  already  in  the  house.  They 
should  in  that  case  be  made  "surgically  clean"  by  washing 
and  heat.  Many  of  the  articles  in  the  list,  those  of  rubber 
and  glass  especially,  can  be  boiled  without  harm.  The  dry 
dressings  can  be  sterilized  by  the  heat  of  a  moderately  hot 
oven— one  in  which  a  pan  of  water  would  simmer  or  boil 
lightly  will  be  quite  hot  enough.  If  the  nurse  be  in  the  house 
in  time,  she  will  attend  to  details,  and  in  any  case  all  the 
necessary  things  to  be  provided  in  advance  should  be 
wrapped  carefully  and  put  where  they  can  be  found  at  once. 
Besides  the  things  to  be  bought  there  will  be  needed  a  dozen 
and  a  half  towels  old  enough  to  be  soft.  These  are  to  be 
put  away  with  the  other  supplies.  At  the  approach  of  labor, 
orders  should  at  once  be  given  that  the  fires  be  kept  up,  so 
that  abundance  of  hot  water  may  be  had;  and  also  that 
a  good  supply  of  ice  be  on  hand,  as  accidents  may  occur  in 
which  both  are  much  needed. 


THE   BABY   BASKET 

Probably  long  before  the  expectant  mother  has  made  the 
preparations  hitherto  described,  she  will  have  been  getting 
ready  all  the  dainty  outfit  of  the  baby.  So  much  of  taste 
and  of  maternal  solicitude  has  from  time  immemorial  gone 
into  the  making  of  baby  clothes  that  one  might  wish  to 
leave  the  subject  in  that  realm  of  esthetic  sentiment.  The 
consideration  of  it  must  nevertheless  take  its  place  with  the 
rest  that  concerns  the  infant. 

The  subject  of  the  infant's  clothing  would  better  be  joined 
to  that  of  clothing  for  children  in  general,  and  will  be  de- 
ferred for  that  chapter.  In  this  place  will  be  mentioned 
only  things  needed  for  the  baby's  first  toilet.  These  are 
the  baby  basket  and  its  contents  and  the  baby's  bath-tub. 


14  THE  CENTURY  BOOK  FOR  MOTHERS 

With  the  growth  of  luxury  the  baby's  basket  has  developed 
from  the  ancient  little  wicker  basket  into  a  great  variety 
and  choice,  from  simple  lined  and  draped  baskets  to  those 
upon  legs,  those  of  hamper  shape  with  a  tray  which  con- 
stitutes the  real  basket,  as  well  as  a  great  number  of  variants 
of  these  patterns  to  be  found  in  the  shops  of  cities.  The 
essential  is  the  basket  to  keep  together  the  toilet  articles. 
The  lining's  and  coverings  are  expressions  of  taste.  The 
smaller,  simple  basket  has  the  advantage  of  taking  less  room ; 
the  basket  on  legs,  a  basket-stand,  is  most  convenient,  being 
of  comfortable  height,  and  saving  a  great  deal  of  stooping, 
which  is  awkward  for  one  holding  an  infant  in  the  lap.  If 
room  or  money  cannot  well  be  spared  for  this  pattern,  the 
common  basket,  when  in  use,  should  be  placed  upon  a  chair 
or  other  suitable  support.  The  hamper  pattern  seems  to 
the  writer  to  have  no  real  advantage,  except  as  an  oppor- 
tunity for  the  display  of  taste.  The  lower  part  of  the  ham- 
per can  only  be  used  to  hold  clothing.  This  has  some  ad- 
vantages, but  also  has  the  disadvantages  of  "living  in  a 
trunk."  Whatever  pattern  is  chosen,  it  is  convenient  to 
have  in  its  lining  various  pockets,  and  to  have  fixed  to  it 
several  cushions  for  pins  and  the  like.  It  is  necessary  that 
this  basket  contain  at  the  time  of  labor  a  number  of  things 
which  will  then  be  needed.     They  are: 

Safety-pins  of  various  sizes. 

Common  pins. 

A  small  roll  of  absorbent  cotton. 

A  number  of  the  cotton  mops  spoken  of. 

Vaseline,  in  tubes,  even  at  the  cost  of  displacing  the  orna- 
mental vaseline- jar. 

Soap  in  a  suitable  closed  box  or  jar;  glass,  celluloid,  and 
metal  are  all  used.     The  first  is  perhaps  the  best. 

A  baby's  hair-brush. 

A  fine-toothed  baby  comb  is  sometimes  added. 

A  very  soft,  fine  sponge  and  a  wash-cloth  of  some  very 
soft  old  material  for  cleansing  folds  and  crevices. 

A  powder-box  and  puff  are  usual  and  sometimes  useful. 


THE  PREPARATION  FOR  MOTHERHOOD       15 

Over  these  two  or  three  towels. 

Over  the  whole  basket  an  old  soft  wrap,  usually  an  old 
blanket,  is  laid  for  the  reception  of  the  baby,  and  on  top 
of  all  the  cut  pieces  of  bobbin,  and,  if  the  nurse  has  not  her 
own  scissors  by  her,  a  stout  pair  of  scissors. 

Besides  all  these  things,  a  suit  of  the  clothes  selected  is 
made  ready.  It  may  be  placed  in  the  basket,  or  the  articles 
may  be  laid,  in  the  reverse  order  of  their  use  (that  is,  that 
to  be  put  on  the  child  last  is  put  on  the  towel  first),  upon  a 
clean  towel  in  some  convenient  place. 

PREPARATIONS   FOR  THE   BATH 

The  bath-tubs  in  commonest  use  are  the  baby's  tin  bath-tub 
or  the  tin  foot-tub  used  for  adults.  These  will  serve  well 
enough  if  placed  upon  two  chairs  or  upon  a  bench  to  raise 
them  to  a  convenient  height.  It  is  easy  to  contrive  ways  in 
which  they  may  be  used  in  connection  with  the  usual  bath- 
room fixtures.  But  no  tub  that  we  have  seen  has  as  many 
advantages  as  the  bath-tub  made  of  a  rubber  sheet  fastened 
to  a  folding-frame,  made  in  imitation  of  the  ancient  cross- 
legged  cot  bedstead.  These  are  sold  in  shops,  and  cost  about 
seven  dollars,  but  they  are  easily  made.  A  carpenter  can 
make  the  folding-frame.  A  strong  band  of  webbing  con- 
nects the  longitudinal  bars  at  either  end.  The  rubber  is 
tacked  to  the  bars  and  stitched  to  the  webbing,  and  the 
whole  is  complete.  Those  sold  in  the  shops  are  often  made 
to  ''knock  down,"  so  that  they  can  be  folded  up,  making  a 
parcel  which  would  slip  into  a  carrier  for  golf-clubs.  But 
this  is  not  essential,  unless  for  a  family  of  very  migratory 
habits.  The  shops  in  great  cities  are  full  of  contrivances 
more  or  less  convenient  for  the  baby's  toilet.  The  writer 
has  endeavored  only  to  mention  those  necessary  or  most 
desirable. 

The  soap  for  the  bath  should  be  bland,  one  of  the  super- 
fatted ones  being  pretty  certain  to  be  unirritating.  Castile 
soap  of  good  quality  has  stood  the  tests  of  generations. 


16        THE  CENTURY  BOOK  FOR  MOTHERS 

The  sponges  must  be  very  fine  and  soft,  and  have  been 
completely  freed  from  sand.  Besides  the  cleansing  which 
has  been  given  the  sponge  before  it  is  sold  at  the  pharma- 
cist's, the  mother  would  do  well  to  spend  some  time  in  soak- 
ing it  and  examining  it  for  hard  substances,  which  are  sur- 
prisingly penetrating  even  to  an  adult's  skin.  These  cling 
closely  to  the  tissues  of  the  sponge,  and  must  be  torn  or  cut 
away. 

PRECAUTIONS   FOR  THE   MOTHER 

The  physician  will  probably  ask  for  a  specimen  of  the  preg- 
nant woman's  urine  by  the  time  she  has  advanced  to  the 
fifth  or  sixth  month.  If,  in  the  pressure  of  his  work,  he  has 
forgotten  to  do  so,  she  should  send  to  him  a  vial  of  urine, 
say  four  ounces,  plainly  marked  with  her  name  and  the 
date  of  the  passing  of  the  water,  with  a  note  asking  how 
frequently  he  desires  subsequent  specimens.  He  will  be 
grateful  for  the  reminder,  as  by  these  specimens  he  can  be 
warned  if  there  be  any  evidence  of  damage  to  the  kidneys. 


THE  VALUE   OF   A   CHEERFUL   FRAME   OF   MIND 

Having,  as  far  as  practicable,  attended  to  her  own  health, 
having  engaged  her  nurse  and  made  all  necessary  provision 
for  the  needs  of  the  lying-in  and  for  the  infant,  the  mother 
ought  to  look  forward  to  her  delivery  with  confident  cheer- 
fulness. Yet  the  pregnant  condition  often  begets  a  depres- 
sion of  spirits,  and  the  delivery  is  looked  forward  to  as  a 
time  of  extreme  peril  rather  than  as  one  of  triumphant  strug- 
gle. This  state  should  be  combated,  not  only  by  the  patient 
herself,  but  by  all  her  intimate  friends.  Nevertheless  there 
are  persons— it  is  difficult  to  find  any  civil  name  for  them— 
whose  morbid  joy  it  is  to  visit  expectant  mothers,  especially 
those  pregnant  for  the  first  time,  and  detail  to  them  all  the 
difficult  or  disastrous  labors  they  have  heard  of,  usually 
with  many  gruesome  exaggerations  of  their  own.  Such  per- 
sons cause  a  deal  of  unnecessary  anxiety  and  suffering.     The 


THE  PREPARATION  FOR  MOTHERHOOD  17 

answer  to  their  croakings  is  this:  that  while  sad  cases  do 
occur,  and  will  occur  again,  universal  experience  shows  that 
the  immense  majority  of  children  come  into  the  world  with 
safety  to  themselves  and  their  mothers,  and  that  what  was 
said  of  old  is  true  to-day:  "As  soon  as  she  is  delivered  of 
the  child,  she  remembereth  no  more  the  anguish,  for  joy 
that  a  man  is  born  into  the  world. ' ' 


II 

THE  NURSERY 

IN  what  is  written  below,  the  nursery  is  understood  to 
be  that  room  or  those  rooms  in  which  young  children, 
and  especially  the  baby,  spend  most  of  their  indoor  hours. 
In  describing  the  requirements  of  a  nursery,  it  must  be 
assumed  that  the  mother  is  free  to  choose  and  arrange  as 
she  will.  But  it  is  also  borne  in  mind  that  means,  occupa- 
tion, and  situation  determine  to  a  great  degree  the  extent 
to  which  nursery  ideals  may  be  attained.  This  book  is 
not  meant  for  the  rich  or  even  the  well-to-do  alone,  and  it 
is  hoped  that  those  of  limited  means  may  find,  in  the  descrip- 
tion of  what  a  nursery  should  be,  hints  which  will  enable 
them  to  make  the  apartment  of  their  little  ones  wholesome 
while  inexpensive.  Whatever  the  home  into  which  the  baby 
comes,  the  newcomer  is  entitled  to  its  best  room— not  merely 
because  it  is  the  long-expected  guest,  but  because  just  in  pro- 
portion to  its  youth  is  it  susceptible  to  the  influence  of  its 
surroundings  for  good  or  evil.  Adults  may  tolerate  rooms, 
may  even  thrive  in  them,  which  would  debilitate,  if  not 
destroy,  a  young  child. 

LIGHT  AND   AIR 

Three  things  are  of  prime  necessity  for  the  nursery— sun- 
shine, air,  and  dryness.  These  are  requisite  for  both  the 
day  nursery  and  the  night  nursery.  If  the  mother's  bed- 
room must  be  the  night  nursery,  or  if  the  family  living-room 
must  be  the  day  nursery,  then  these  rooms  should,  as  far  as 

18 


THE  NURSERY  19 

practicable,  be  selected  wdth  reference  to  the  needs  of  a  nur- 
sery. To  insure  sunshine,  of  course  the  south  is  the  best 
exposure;  next  to  it,  we  think,  in  this  climate,  is  the  east, 
as  the  morning  sunshine  coincides  better  with  the  child's 
waking  hours  than  that  of  the  afternoon;  in  other  respects 
the  western  sun  is  practically  as  good.  So  valuable  is  the 
sunshine  as  a  purifier  that  even  in  summer  a  sunny  room, 
although  it  may  have  to  be  screened  with  shades  or  awnings, 
is  better  than  one  into  which  sunshine  does  not  come.  The 
air-supply  must  be  pure  in  quality  and  adequate  in  quan- 
tity, and  the  apartment  must  be  as  dry  as  possible.  All 
three  of  these  main  requirements— sun,  air,  and  dryness— 
are  better  satisfied  in  a  room  well  elevated  from  the  ground : 
an  up-stairs  room  being  best,  but  not  one  under  the  roof, 
which  would  feel  changes  of  heat  and  cold  in  an  exagger- 
ated degree. 

VENTILATION   AND   HEATING 

The  question  of  ventilation  involves  not  only  the  air-supply, 
but  the  getting  out  of  the  foul  air.  There  is  no  necessary 
connection  between  it  and  the  problem  of  heating;  never- 
theless the  apparatus  generally  employed  for  heating  our 
houses  is  in  cold  weather  very  largely  concerned  in  the 
change  of  air  in  the  rooms.  Our  common  methods  of  heat- 
ing are  much  more  satisfactory  than  our  ventilation,  and 
in  ordinary  houses  the  ingress  of  fresh  air  is  much  better 
provided  for  than  is  the  egress  of  vitiated  air. 

The  most  ancient  form  of  heating  apparatus  is  the  open 
fireplace.  It  is  very  wasteful  of  heat,  heats  the  room  un- 
evenly, but  is  admirable  for  ventilation.  In  fact,  even  a 
furnace-warmed  room  in  which  there  is  an  open  fireplace 
is  likely  to  be  fairly  well  ventilated.  But  its  ventilating 
power  and  its  unequal  heating  make  it  a  great  producer  of 
drafts,  and  the  floor  in  its  vicinity  is  a  dangerous  place  for 
a  child  in  a  room  so  heated.  The  danger  to  children  from 
the  fire  can  be  guarded  against  by  a  high  wire  fender  fas- 
tened in  place  by  some  adjustable  contrivance. 


20  THE  CENTURY  BOOK  FOR  MOTHERS 

The  next  is  the  box  or  " air-tight''  stove,  which  is  a  pow- 
erful heater,  but  makes  no  provision  for  ventilation.  It 
needs  a  guard  to  prevent  burns,  much  as  does  the  open  fire. 
The  Franklin  stove  was  invented  to  save  heat  while  preserv- 
ing some  of  the  advantages  of  the  open  fire,  and  is  a  fair 
sort  of  compromise.  There  are  various  kinds  of  jacketed 
stoves  with  a  cold-air  supply  from  out  of  doors,  quite  satis- 
factory for  very  large  rooms,  but  not  very  practicable  for 
ordinary  houses. 

If  the  fireplace,  stove,  or  Franklin  is  used,  the  supply  of 
fresh  air  practically  comes  from  the  windows  and  doors  by 
penetrating  through  the  cracks,  unless  some  arrangement  be 
made  to  admit  it  more  systematically.  Various  patented 
devices  for  window-boards  are  in  use,  such  as  the  elbow- 
tubes,  which  throw  the  air-current  directly  upward,  which 
is  unobjectionable.  But  it  is  not  certain  that  they  have 
real  advantages  over  the  old-fashioned,  simple  window-board, 
two  forms  of  which  are  common.  One  consists  of  a  stout 
board,  about  four  inches  wide,  which  fits  into  the  window- 
frame,  the  bottom  of  the  lower  sash  resting  upon  it  snugly. 
The  upper  edge  of  this  board  may  be  covered  with  felt  to 
insure  neater  contact.  The  sash  being  thus  raised,  air  enters 
at  its  junction  with  the  upper  sash,  the  current  being  di- 
rected upward,  and  the  fresh,  cool  air  is  gradually  diffused 
about  the  room,  instead  of  entering  as  a  horizontal  and  prob- 
ably injurious  draft.  The  other  form  of  the  board  differs 
from  that  just  described  only  in  being  somewhat  wider,  six 
to  eight  inches,  and  being  placed  against  the  sash,  felt  being 
interposed  if  desired.  By  this  arrangement  the  lower  sash 
may  be  raised  so  that  its  bottom  nearly  reaches  the  top  of 
the  board  or  to  any  less  height,  or  it  may  be  closed  com- 
pletely at  will. 

In  towns  generally,  and  in  many  country  houses,  some 
form  of  furnace  heating  is  employed,  alone  or  in  combina- 
tion with  fireplaces.  The  commonest  as  well  as  the  oldest 
type  is  the  hot-air  furnace.    Steam  and  hot- water  heating  are 


THE  NURSERY  21 

more  recent  and  relatively  infrequent.  Electric  heating  at 
the  present  time  is  hardly  introduced  into  private  houses. 
The  common  hot-air  furnace  has  the  advantage  that  the  air 
to  be  heated  is  drawn  from  out  of  doors,  and  with  very 
simple  precautions  can  be  made  fairly  pure.  These  precau- 
tions consist  in  taking  the  cold  air  at  a  height  above  the 
ground  surface,  as  may  be  easily  done  by  carrying  the  end 
of  the  flue  up  from  six  to  ten  feet  and  reversing  its  extremity, 
so  that  neither  rain  nor  dirt  shall  fall  into  it.  The  open  end 
should  be  protected  by  a  wire  screen,  to  prevent  things  being 
thrown  in  or  animals  crawling  in.  One  common  defect  is 
that  the  furnace  is  so  arranged  or  so  managed  that  it  delivers 
a  small  quantity  of  very  hot  air,  whereas  a  larger  volume 
of  air  not  so  highly  heated  would  be  more  advantageous. 
Of  the  other  types  the  hot- water  seems  the  more  manageable, 
but  neither  has  any  necessary  connection  with  air-supply. 

It  will  be  noticed  that  none  of  these  plans  of  heating,  except 
the  open  fire,  includes  any  plan  of  getting  rid  of  the  vitiated 
air.  If  an  open  fireplace  exists  and  the  registers  for  hot  air 
be  placed  high  on  the  wall,  a  very  satisfactory  form  of  ''base 
ventilation"  exists.  If  no  fireplace  exists  and  no  system  of 
ventilation  was  included  in  the  building  of  the  house,  it  is 
very  difficult  to  keep  the  air  of  the  nursery  sweet,  except 
by  constant  attention  to  the  airing  of  the  room.  A  device 
which  is  not  very  expensive  can  be  employed  if  there  be  a 
chimney  accessible.  It  is  to  carry  a  ventilating-pipe,  the 
mouth  of  which  is  near  the  floor  of  the  nursery,  into  and  for 
some  distance  up  the  chimney-flue.  The  heat  of  the  chim- 
ney creates  a  current  of  air  upward  in  the  pipe,  which  is 
replaced  by  the  air  from  the  nursery.  If  the  pipe  can  be 
carried  to  the  roof  it  need  only  be  against  the  chimney  and 
not  be  within  it. 

Gas-stoves  should  never  be  used,  as  they  vitiate  an  enor- 
mous amount  of  air,  unless  they  are  set,  like  a  ''gas-log,*' 
into  the  fireplace,  Avhere  their  combustion  products  can 
escape  up  the  chimney. 


22  THE  CENTURY  BOOK  FOR  MOTHERS 

THE   PROPER   TEMPERATURE 

The  temperature  of  the  nursery  is  usually  much  too  high. 
It  should  not  be  higher  than  70°  F.  If  uniformity  could  be 
secured,  probably  65°  F.  would  be  sufficiently  high.  The 
night  temperature  should  remain  as  near  to  the  latter  figure 
as  practicable,  but,  despite  great  care,  the  temperature  will 
often  fall  in  the  latter  part  of  the  night.  A  source  of  chill 
ought  to  be  mentioned— namely,  the  windows;  not  through 
ingress  of  air  from  without,  but  by  the  rapid  cooling  of 
air  next  the  glass,  Avhich  pours  down  upon  the  floor  to  in- 
crease the  drafts  of  the  room.  If  the  child 's  bed  is  unavoid- 
ably near  a  window,  in  cool  weather  it  should  be  especially 
protected  by  screens;  and  it  is  well  to  make  the  window 
inaccessible  to  the  young  children  by  placing  before  it  some 
piece  of  furniture  not  high  enough  to  obstruct  light  or  dimin- 
ish its  usefulness. 

LIGHTS 

Unfortunately,  the  same  objection  made  against  gas-stoves 
must  be  made  to  some  degree  to  all  lights,  except  the  elec- 
tric, and  this  is  usually  too  bright  for  anything  but  full 
illumination.  A  large  gas-flame  or  kerosene-lamp  consumes 
as  much  oxygen  as  five  or  six  adults  in  the  room  would. 
Small  lights,  therefore,  are  to  be  used,  except  when  large 
ones  are  really  necessary.  The  lamp  or  gas  can  be  utilized, 
however,  to  favor  ventilation,  if  a  ventilating-pipe  as  just 
described  exists,  by  having  its  open  end  wide  enough  so 
that  the  lamp  or  burner  may  be  placed  beneath  it. 

The  most  convenient  portable  night  light  which  we  know 
is  that  called  the  '^ Pyramid  Night  Light."  It  is  a  short, 
stout  candle  in  a  plaster-of -Paris  base.  This  fits  a  metallic 
stand,  and  is  covered  by  a  shade  or  chimney  of  truncated 
conical  shape.  It  will  burn  long  enough  to  last  from  the 
mother's  ordinary  bedtime  until  daylight.  The  old-fash- 
ioned floating  night  light  is  obsolete.  There  are  made  also 
small  kerosene-lamps  which  burn  with  a  very  small  flame. 


THE  NURSERY  23 

If  the  flame  is  carefully  adjusted  so  that  it  burns  without 
odor,  they  serve  very  well  •  if  not,  these  lamps  are  unsuit- 
able to  the  nursery. 


NURSERY   FURNISHINGS 

Windows  should  have  guards  within  or  without,  to  prevent 
a  child  from  falling  out;  and  blinds  or  dark  shades,  to  tem- 
per the  light,  are  necessary.  Similar  guards  should  be  at 
the  doors  or  stair-heads  when  the  children  are  large  enough 
to  run  about. 

Since  in  most  houses  the  nursery  must,  in  case  of  any 
sickness,  be  the  hospital  as  well,  some  parts  of  its  structure 
and  all  of  its  furnishing  must  be  in  conformity  to  this  pos- 
sible use.  Its  floor  must  be  smooth,  so  that  it  can  be  made 
clean  and  kept  clean.  It  is  best  made  of  narrow,  hardwood 
boards  well  and  closely  laid,  the  cracks  filled  with  putty  or 
some  of  the  preparations  made  for  the  purpose,  and  well 
varnished.  Cheap  carpets  in  rug  form  are  best.  The  walls 
are  best  painted;  if  papered  it  should  be  Avith  some  of  the 
varnished  washable  papers  often  used  in  bath-rooms.  Every- 
thing should  be  plain  and  substantial  and  with  as  few  dirt- 
catching  recesses  as  possible.  Everything,  in  fact,  in  a  nur- 
sery should  be  selected  after  considering  two  questions: 
Can  it  be  kept  thoroughly  clean  or  completely  disinfected 
if  contaminated?  and.  Can  I  afford  to  destroy  it  if  I  can- 
not make  it  entirely  pure  ? 

For  these  reasons  the  furniture  should  be  devoid  of  orna- 
ment. The  bedsteads  are  best  of  metal,  those  of  painted 
iron  having  most  advantages;  the  design  known  as  the  hos- 
pital pattern  is  probably  best  of  all.  There  should  be  no 
curtains  save  such  as  can  be  boiled  or  steamed.  The  mat- 
tress and  pillow  should  be  of  good  hair,  and  the  former  pro- 
tected from  wetting  or  soiling  by  a  rubber  sheet.  Of  course, 
the  child's  bed,  if  possible,  should  not  be  shared  by  an  adult, 
and  the  child  should  either  have  its  own  bureau  or  cup- 
board, or  at  least  its  own  drawers  in  the  bureau.     Save  for 


34  THE  CENTURY  BOOK  FOR  MOTHERS 

the  turmoil  and  disarrangement  of  "sweeping  days,"  an 
open  cupboard  of  shelves  closed  with  a  curtain  would  prob- 
ably be  kept  in  better  order  than  any  device  shut  up  from 
inspection.  In  any  case,  these  necessary  receptacles  should 
be  arranged  so  as  to  be  kept  clean  and  aired  with  the  least 
trouble.  Hence  shelves  within  easy  reach  and  not  far  apart, 
so  that  many  things  are  not  necessarily  put  into  one  pile, 
are  better  than  inaccessible  drawers. 

The  same  reasons  of  cleanliness,  not  to  mention  possibili- 
ties of  infection,  make  it  advisable  that  there  should  be  no 
plumbing  in  the  nursery,  and  that  the  latter  should  not 
connect  with,  and  preferably  should  not  be  near  to,  a  water- 
closet  or  even  a  bath-room.  The  convenience  of  such  near- 
ness is  often  dearly  paid  for. 

The  furniture,  other  than  the  bedstead,  cannot  well  be  of 
metal,  and  should  be  carefully  selected  according  to  the 
simple  rules  just  given.  Chairs  of  plain  and  solid  structure 
—for  instance,  of  bent  wood  and  with  cane  seats— are  far 
preferable  to  those  of  ornamental  design,  of  wickerwork,  or 
upholstered. 

Thus  far  nothing  has  been  said  concerning  a  day  nursery. 
If  one  can  be  afforded  as  well  as  a  night  nursery,  so  much 
the  better.  In  that  case  its  sanitary  arrangements  will  be 
the  same  as  those  described  for  the  nursery  of  all  work.  If 
the  child  is  to  sleep  ^vith  its  mother,  then  the  nursery  be- 
comes a  day  nursery,  and  the  mother's  bedroom  must  be 
arranged  on  a  plan  to  suit  the  needs  of  a  night  nursery. 


Ill 

THE  NEW  BABY 

WHEN  the  infant  has  been  delivered— has  manifested 
its  presence  most  probably  by  loud  cries— the  physi- 
cian ties  the  cord,  divides  it,  and  lays  the  child,  warmly 
wrapped  in  the  blanket  provided,  aside  in  a  safe  place,  while 
he  attends  to  the  safety  and  comfort  of  the  mother.  When 
at  length  he  can  properly  do  so,  he  returns  to  the  infant, 
and  quickly  and  carefully  inspects  it  to  ascertain  if  it  be 
normal  in  development,  whether  there  be  defects  or  blem- 
ishes. Those  first  looked  for  are  usually  defects  the  existence 
of  which  would  imperil  its  life  or  hinder  its  nutrition,  and 
these  are  especially  imperforate  anus,  defects  or  obstructions 
of  the  urinary  organs,  and  harelip.  The  latter  interferes 
directly  with  sucking,  hence  with  the  nutrition  of  the  babe ; 
the  anal  obstruction,  if  not  relieved  by  surgery,  must  soon 
destroy  the  child;  while  the  urinary  organs,  being  more 
often  imperfect  than  obstructed,  are  less  likely  to  threaten 
the  existence  of  the  child  through  their  defects,  and  do  not 
need  such  immediate  surgical  attention.  He  will  notice, 
also,  if  they  exist,  striking  moles,  supernumerary  fingers,  or 
club-feet.  These  deformities  or  defects  are  the  physician's 
particular  care.  He  will  judge,  as  to  moles,  whether  or  not 
they  can  be  removed,  as  to  supernumerary  digits,  the  proper 
time  for  their  removal,  and  will  as  soon  as  possible  instruct 
the  nurse  in  the  proper  manipulations  which  favor  the  cure 
of  club-foot. 

25 


26  THE  CENTURY  BOOK  FOR  MOTHERS 

BABY'S   FIRST   BATH 

Fortunately,  all  these  deformities,  although  more  common 
than  others,  are  relatively  rare,  and  the  cares  of  the  nurse 
are  usually  only  those  which  every  healthy  baby  demands. 
Baby's  first  bath  involves  a  little  more  detail  than  its  sub- 
sequent ablutions,  and  it  may  be  described  with  advantage. 
This  bath  cannot,  of  course,  be  given  by  the  mother,  but  it 
may  be  useful  for  her  to  know  its  method.^ 

The  nurse  has  already  gathered  about  the  fire  or  the  source 
of  heat  in  the  room  the  necessary  utensils— tub,  towels,  soap, 
hot  and  cold  water,  oil  or  some  kind  of  grease,  powder,  and 
the  child's  garments.  She  puts  on  a  flannel  apron  or  lays 
over  her  lap  a  thin  soft  blanket.  She  takes  the  child  in 
its  wraps  and  sits  in  a  low  chair,  with  the  baby  in  her  lap. 
As  the  wraps  are  removed  the  child's  body  is  found  to  be 
partly  or  wholly  covered  with  a  greasy,  pasty  substance 
called  vernix  caseosa,  meaning  cheesy  varnish.  The  amount 
of  this  varies  considerably  in  different  children.  Into  this 
the  grease  is  well  rubbed  before  washing.  Vaseline  is  nowa- 
days most  commonly  used,  but  lard  or  oil  is  at  least  equally 
good.  The  grease  is  rubbed  thoroughly  but  gently  all  over 
the  body,  and  with  especial  care  into  the  armpits,  the  groins, 
around  the  genitals,  and  into  every  crease  or  fold  of  the 
skin.  If  the  varnish  is  very  tough  or  adhesive,  or  if  the 
child  be  not  very  strong,  the  washing  may  be  deferred,  the 
child,  after  the  inunction,  being  again  rolled  up  warmly  and 
left  to  rest.  Ordinarily,  however,  the  bathing  immediately 
follows. 

The  cheesy  matter  loosened  by  the  grease  is  wiped  oft' 
with  a  soft  cloth  or  the  wrapping-sheet,  and  then  every  part 
is  carefully  washed  with  soap  and  water.     The  child  before 

1  It  may  be  mentioned  that  some  head,  protecting  it  until  the  time 

physicians,at  least  in  hospital  prac-  at  which  it  is  to  be  washed.    But 

tice,  prefer  not  to  wash  the  infant  the  detail  of  the  first  bath  remains 

at  once,    but  place  it  in  a  warm  the  same  whenever  it  is  given, 
bag,  which   covers    it,   except    the 


THE  NEW  BABY  27 

birth  had  been  kept  in  a  surrounding  medium  at  about  a 
temperature  of  100°  F.,  and  that  of  the  bath  should  be  prac- 
tically the  same.  Cheap  bath-thermometers  are  everywhere 
to  be  had  nowadays.  An  ancient  traditional  substitute  was 
the  elbow^  of  the  nurse's  bared  arm,  which  is  more  sensitive 
than  her  hand.  After  thorough  soaping  the  child  is  im- 
mersed for  a  few  moments  in  the  bath  at  the  temperature  of 
from  98°  to  100°  F.  It  is  sometimes  convenient  to  do  the  pre- 
liminary lathering  with  the  aid  of  a  basin  separate  from  the 
tub,  but  it  is  not  necessary.  As  it  is  often  necessary  to 
spend  quite  a  little  time  in  cleaning  out  the  folds  and  creases, 
it  is  better  that  only  that  part  of  the  body  which  is  being 
cleansed  should  be  exposed  at  one  time.  In  the  immersion 
of  the  child  a  little  dexterity  is  required  to  prevent  the 
child's  slipping  from  the  hands.  The  usual  manoeuver  is 
this:  The  child's  head  and  shoulders  are  supported  upon 
the  nurse's  left  palm  and  wrist,  the  first  and  second  fingers 
of  that  hand  go  into  the  farther  armpit  {i.  e.,  the  baby's 
left),  Avhile  the  thumb  steadies  the  shoulder.  The  nurse's 
right  hand  supports  and  grasps  the  lower  part  of  the  baby's 
thighs  and  knees.  The  child  is  raised  from  the  lap  and  slid 
into  the  water,  the  left  hand  continuing  to  support  the  head 
above  the  water.  The  right  may  assist  in  the  rinsing  if 
necessary.  The  child  is  then  lifted  back  into  the  lap  and 
dried  very  carefully  with  a  large,  soft  towel,  which  should 
envelop  the  baby  during  the  process.  If,  as  is  usual,  there 
be  an  admiring  spectator  of  this  first  bath,  she  can  assist  by 
laying  this  towel  upon  the  nurse's  lap  in  advance.  All  the 
folds  before  mentioned  must  be  dried  most  carefully.  If  it 
be  well  and  thoroughly  done,  toilet-powder  is  not  necessary, 
but  it  is  admissible,  and  its  use  is  preferable  to  the  leaving  of 
any  dampness,  the  function  of  powder  being  only  as  a  drier. 


SPECIAL  PRECAUTIONS 

Two  or  three  points  should  be  especially  mentioned  in  con- 
nection with  the  bath— namely,  the  cleansing  of  the  scalp. 


28        THE  CENTURY  BOOK  FOR  MOTHERS 

of  the  eyes,  ears,  nose,  and  mouth,  and  the  care  of  the  navel. 
The  scalp  differs  from  the  rest  of  the  surface  only  in  that 
it  demands  more  care  in  many  cases  to  keep  it  clean.  The 
eyes  should  be  very  carefully  cleaned  even  before  the  bath, 
and  nurses  trained  in  hospitals  often  wash  the  eyes  with  a 
solution  of  boric  acid  as  soon  as  the  physician  hands  them 
the  baby.  In  many  lying-in  hospitals  it  is  customary  to  make 
a  still  stronger  application,  such  as  a  solution  of  a  salt  of 
silver,  to  the  eyes  of  the  new-born  as  a  preventive  of  infec- 
tion from  the  mother's  passages  at  the  time  of  birth.  This 
detail  is  not  generally  adopted  as  a  routine  in  private  prac- 
tice. The  ears  should  have  especial  care,  owing  to  the  many 
places  where  dirt  may  linger;  and  the  nose  should  be  care- 
fully freed  from  discharges,  which  may  subsequently  prove 
irritating.  The  mouth  must  be  cleansed,  not  only  at  this 
first  bath,  but,  like  the  eyes,  at  every  bath,  with  a  separate 
bit  of  rag  or  absorbent  cotton,  either  with  pure  cold  water 
(preferably  water  which  has  been  boiled)  or  with  a  solution 
of  boric  acid. 

THE  NAVEL-STRING 

The  piece  of  the  umbilical  cord,  or  navel-string,  between  the 
point  where  it  w^as  tied  and  the  navel  itself,  separates  natu- 
rally from  the  navel  about  the  fifth  day.  During  the  inter- 
vening time  the  moisture  from  it  soils  the  wrappings  or  gar- 
ments, and  may  smell  unpleasantly  from  decomposition. 
Various  devices  have  been  employed  to  combat  this,  from  the 
traditional  antiseptic  of  burned  linen  down.  At  the  present 
time  there  seems  to  be  no  method  more  generally  applicable 
or  advantageous  than  to  envelop  the  piece  of  cord,  doubled 
upon  itself  if  it  be  long  enough,  mth  a  fair-sized  wad  of 
absorbent  cotton,  taking  pains  to  cover  smoothly  all  the  cord. 
This  absorbent  cotton  takes  up  the  moisture  as  it  exudes, 
and  any  disagreeable  odor  can  be  prevented  by  dusting  the 
cord  with  a  little  boric  acid  or  salicylic  acid  at  the  first  dress- 
ing, and  dusting  the  cotton  at  the  daily  bath  if  necessary. 
The  whole  is  kept  in  place  by  the  flannel  band  usually  placed 


THE  NEW  BABY  29 

around  the  child's  abdomen.  The  cord  is  usually  dressed 
upon  the  left  side,  the  reason  assigned  being  that  thus  pres- 
sure upon  the  large  liver  is  avoided.  When  the  cord  falls 
off  a  small  raw  surface  remains,  which  heals  in  a  few  days 
if  simply  kept  dry.  If  slow  in  healing  or  inclined  to  be 
moist  it  may  be  dusted  with  a  little  bismuth  powder,  the 
subgallate  being  the  preferable  preparation.  Some  physi- 
cians prefer  a  mixture  of  starch  powder  and  salicylic  acid, 
which  is  likewise  a  drying  and  antiseptic  preparation.  Im- 
mersion baths  are  not  repeated  until  after  the  cord  has 
dropped  off,  daily  sponge-baths  of  simple  water  being 
enough.  After  the  separation  the  tub  may  be  resumed  if 
the  child  is  of  average  strength.  Besides  the  daily  bath, 
sponging  of  the  soiled  parts  is  necessary  whenever  the  nap- 
kins are  changed. 


IV 

NURSERY   ROUTINE 

AFTER  the  monthly  nurse  leaves  the  mother's  condition 
JIjl  suddenly  changes  from  that  of  one  closely  cared  for  to 
that  of  a  caretaker.  If  she  has  had  the  good  fortune  to 
have  one  of  those  nurses  who  are  not  only  competent  to  do 
their  work  well,  but  facile  in  teaching  others,  the  beginning 
of  the  task  will  not  be  difficult.  At  all  events,  if  the  mother 
has  been  watchful  and  observant  she  should  know  pretty 
well  what  is  to  be  done.  Her  chief  cares  will  be  not  to 
carry  her  task  too  anxiously,  and  to  do  her  work  in  such  a 
way  as  shall  not  only  meet  the  child's  immediate  needs,  but 
train  it  into  good  habits.  These  needs  are  born  with  the 
child,  its  habits  are  to  be  acquired;  and  it  is  probable  that 
during  the  nurse's  incumbency  most  of  the  infant's  func- 
tions have  been  regulated  and  many  of  its  habits  already 
formed.  If  these  habits  are  good,  the  mother's  task  will  be 
easy;  if  not,  the  correcting  them  will  increase  her  burden. 
Habits  are  good  when  the  needs  of  life  are  met  in  a  regular 
and  desirable  way,  and  ordinarily  they  are  as  easily  formed 
in  the  right  direction  as  the  wrong,  if  a  little  thought  be 
taken  and  forethought  used. 

HOURS   OF   SLEEP 

The  new  infant's  life  is  essentially  one  of  eating  and  sleep- 
ing. In  its  earlier  weeks,  probably  it  is  awake  not  more  than 
two  hours  in  the  twenty-four,  and  this  may  still  be  the  case 
when  the  nurse  leaves.  Three  hours  will  certainly  cover 
its  waking  time,  which  is  divided  into  portions  of  from  a 

30 


NURSERY  ROUTINE  31 

quarter  of  an  hour  to  an  hour,  unless  possibly  its  morning 
bath  may  keep  it  awake  longer  at  that  time  of  day. 

The  waking  hours  gradually  increase,  so  that  at  six  months 
they  may  amount  to  six  or  even  more  hours  in  the  day.  At  a 
year,  a  long  morning  nap  and  a  short  one  after  noon  are 
usual,  besides  an  all-night's  sleep.  And  the  practice  of  a 
daily  nap  should  be  encouraged  as  long  as  possible.  Some 
healthy  children  continue  it  until  six  or  seven  years  of  age, 
and  some,  equally  healthy,  are  too  active  to  take  a  day  nap 
after  three  years.  Now,  the  infant  whose  needs— warmth, 
food,  and  quiet— are  supplied,  will  sleep,  and  nothing  more  is 
needed.  Doubtless  the  habit  of  rocking  or  cuddling  a  child 
to  sleep  begins  through  tenderness,  but  it  presently  becomes 
a  bondage ;  and  many  of  the  methods  employed— thumb-suck- 
ing, sugar-teats,  rubber  nipples,  etc.— are  objectionable  at 
the  very  least,  and  often  injurious.  The  writer  has  known 
some  children  of  ten  or  more  years  who  still  required  some 
absurd  device  to  induce  sleep.  When,  therefore,  the  child 
has  been  dressed,  bathed,  or  fed,  according  to  whichever 
may  at  the  time  be  due,  it  should  be  placed  in  a  comfortable 
position  in  its  bed  and  let  alone.  Obviously,  it  is  better  both 
for  the  parents  and  for  the  child,  after  a  little  time,  that  its 
sleeping  and  waking  hours  should  correspond  as  far  as  prac- 
ticable with  those  of  adults.  So  the  infant  should  not  be 
allowed  to  sleep  indefinitely  and  wake  irregularly,  but  should 
be  wakened  regularly  at  the  hours  of  feeding,  and  again  put 
to  rest  through  the  day,  and  at  night  be  allowed  to  sleep  at 
a  time  so  long  as  may  be  thought  proper  for  its  age,  which 
is  practically  as  long  as  it  will  sleep,  or  as  the  fullness  of  the 
mother's  breast  will  permit.  At  night  the  intervals  of  wak- 
ing are  at  first  about  twice  as  far  apart  as  the  day  wakings. 
So  that,  assuming  that  when  the  nurse  leaves  the  baby  is 
suckled  or  fed  every  two  and  one  half  hours  during  the  day, 
it  will  go  five  hours  at  night,  which  will  give  but  one  meal 
between  the  mother's  bedtime  and  her  time  of  rising.  This 
night  meal  is  usually  too  long  continued.  It  is  not  necessary 
after  the  child  is  five,  or  at  most  six,  months  of  age.     The 


32  THE  CENTURY  BOOK  FOR  MOTHERS 

child's  sleeping  hours  are  therefore  largely  conditioned  by 
the  times  of  feeding;  and  if  the  breast  supply  is  adequate 
or  the  artificial  food  properly  adjusted,  the  hours  of  sleep, 
if  the  child  be  in  health,  should  take  care  of  themselves. 
The  regularity  of  habits  regarding  sleep  has  another  advan- 
tage, which  may  be  here  mentioned,  although  its  value  is 
greater  later  than  in  infancy.  Hours  of  rest,  even  without 
sleep,  are  exceedingly  valuable  to  active  children,  and,  above 
all,  to  those  of  excitable  nervous  system.  If  the  sleeping 
times  have  been  regular,  and  the  child  is  accustomed  to  being 
put  to  bed  without  any  of  the  artificial  inducers  of  sleep 
before  alluded  to,  it  is  easy  to  make  it  lie  down  and  rest 
or  amuse  itself  with  some  unexciting  toy  or  book,  if  it  be 
old  enough,  while  without  regular  habits  the  attempt  would 
be  only  a  vexation  to  all  concerned. 

The  amount  of  sleep  needed  will  vary  somewhat  with  chil- 
dren; yet  in  a  general  way  it  is  true,  as  long  since  pointed 
out,  that  the  child  who  sleeps  well  thrives— that  is  to  say, 
its  functions  are  well  performed,  its  nutrition  satisfactory, 
and  its  wear  and  tear  easily  repaired.  As  has  been  said,  the 
infant  sleeps  about  all  the  time,  unless  waking  for  a  definite 
purpose,  such  as  feeding  or  its  toilet.  A  year-old  child 
sleeps  more  than  half  the  time.  Up  to  three  or  four  years, 
probably  twelve  hours  in  the  twenty- four  would  not  be  much 
above  the  average,  and  until  puberty  it  is  well  to  try  to 
give  a  child  ten  hours  of  sleep  daily. 

DISTURBED   SLEEP 

Disorders  of  sleep  are  not  common  in  infancy,  nor  in  child- 
hood are  they  as  frequent  as  in  adult  life.  In  infancy  dis- 
turbances of  sleep  generally  take  the  form  of  restlessness  and 
sometimes  of  dreams.  Usually  some  pain  or  distinct  trouble 
or  discomfort  may  be  found  as  the  cause,  such  as  the  uneasi- 
ness, direct  or  reflex,  caused  by  dentition,  by  earaches,  con- 
stipation, indigestion,  or  overfeeding,  or  the  general  disturb- 
ance accompanying  any  febrile  condition. 


NURSERY  ROUTINE  33 

After  infancy  disturbances  are  more  common,  and  that 
one  concerning  which  physicians  are  more  consulted  per- 
haps than  any  other— namely,  night  terrors— is  most  fre- 
quent, say,  from  three  to  six  years  of  age.  This  affection  is 
distressing  to  see.  The  child  is  usually  found  sitting  or  cow- 
ering, often  shrieking,  sometimes  covered  with  the  sweat  of 
terror,  and  shrinking  from  some  object  of  horror.  This  may 
be  something  definite,  some  person  or  beast,  or  some  other 
thing  of  which  it  is  in  great  dread.  Quite  as  commonly  the 
terror  is  of  something  which  it  cannot  or  does  not  indicate. 
The  most  distressing  feature  to  the  parent  or  nurse  is  that 
the  child  very  likely  does  not  recognize  it,  and  refuses  the 
proffered  comfort.  As  complete  consciousness  returns,  rec- 
ognition returns  with  it  and  the  reassurances  are  accepted, 
and  before  long  the  child  goes  into  a  sound  sleep  of  weari- 
ness. The  attack  is  rarely  repeated  the  same  night,  nor  is 
it  usual  that  they  come  in  successive  nights.  Ordinarily 
there  is  quite  an  interval. 

The  causes  of  such  attacks  are  often  quite  clearly  recog- 
nized, sometimes,  however,  not  at  all.  In  the  first  place,  the 
children  who  are  subject  to  them  are  usually — not  always — 
delicate,  feeble,  or  nervous.  Again,  more  often  than  not, 
some  physical  irritation,  especially  of  the  digestive  organs, 
may  be  recognized ;  or  there  is  the  story  of  alarming  occur- 
rences in  the  daytime,  or  exciting  or  injudicious  story-telling 
before  the  child  is  put  to  bed.  Any  error  of  physical  or 
mental  hygiene  may  be  the  exciting  cause.  Nevertheless 
cases  do  occur  in  which  no  causation  can  be  certainly 
found. 

A  few  of  these  cases  prove  to  be  nocturnal  epilepsy,  and 
a  few  others  to  be  manifestations  of  cerebral  troubles  of  one 
sort  or  another.  As  a  rule,  however,  the  peculiarity  passes 
away  either  by  the  diminution  of  the  peculiar  susceptibility 
or  the  removal  of  the  exciting  causes. 

It  will  be  noticed  that  the  condition  known  in  adults  as 
nightmare  and  rarely  seen  in  children,  lies  between  the  com- 
mon dreams  and  this  more  distressing  malady.     Also  akin 

3 


34         THE  CENTURY  BOOK  FOR  MOTHERS 

to  it  are  sleep-walking  and  similar  manifestations  of  activity 
during  sleep. 

As  to  cure,  the  efforts  of  the  parent,  with  medical  assistance 
if  necessary,  must  be  directed  to  the  strengthening  and  im- 
proving of  the  general  condition  of  the  child  and  the  remov- 
ing and  preventing  of  all  recognizable  sources  of  irritation. 

SUCKLING 

The  question  of  artificial  feeding  is  such  a  wide  one  that  it 
will  be  deferred  for  consideration  by  itself.  But  the  matter 
of  suckling  may  be  here  spoken  of. 

During  the  first  month  of  the  child's  life  it  should  be 
suckled  every  two  hours,  counting  from  the  beginning  of  one 
nursing  to  the  beginning  of  the  next.  During  the  second 
and  third  months  the  interval  should  be  two  and  one  half 
hours,  and  after  three  months  have  been  reached  three  hours. 
Nothing  is  gained  by  more  frequent  suckling,  and  a  good 
many  harmful  consequences  may  result.  It  is  not  meant 
that  every  child  requires  just  the  same  amount  of  food  or 
frequency  of  meals.  But  in  every  case  regularity  is  of  the 
first  importance.  Further,  if  an  infant  in  ordinarily  good 
condition  is  not  content  and  properly  nourished  when  nursed 
as  above,  there  is  reason  to  suspect  that  the  food  itself  is 
deficient  either  in  quantity  or  quality.  More  frequent  put- 
ting of  the  child  to  the  breast  is  not  likely  to  increase  the 
one  or  improve  the  other. 

The  evidences  of  suitable  and  abundant  breast  milk  are  a 
fairly  prompt  completion  of  the  nursing,  followed  directly 
by  a  good  sleep  lasting  nearly  or  quite  until  the  next  nursing 
time,  a  contented  condition  when  awake,  regularity  of  the 
bowels,  and  a  satisfactory  and  progressive  gain  in  weight. 
The  contrary  of  these— namely,  prolonged  sucking  ^vithout 
evident  satisfaction,  broken  or  short  sleep,  fretfulness,  bowel 
disorders  of  various  sorts,  and  insufficient  gain  and,  in  the 
later  months  of  the  ordinary  period  of  suckling,  a  delay  of 
the  usual  signs  of  development  (see  chapter  on  "Growth  and 


NURSERY  ROUTINE  35 

Development")— are  to  be  counted  as  probable  evidence  of 
defective  quality  or  quantity  of  the  breast  milk.  Whenever 
such  symptoms  occur,  the  question  of  artificial  feeding, 
wholly  or  supplementary  to  the  breast,  arises. 

CRYING 

A  WORD  here  is  proper  regarding  crying.  While  the  un- 
derfed child  does  cry,  is  usually  fretful  and  peevish,  it  does 
not  follow  that  every  cry  is  a  call  for  food.  Many  times 
the  little  creature,  who  has  "no  language  but  a  cry,"  is 
thirsty,  and  a  teaspoonful  of  water  will  be  the  best  satis- 
faction. Very  often,  indeed,  the  cry  is  the  expression  of 
overfeeding  and  internal  discomfort,  although  this  is  far 
less  frequent  with  suckled  than  with  bottle-fed  infants.  In 
the  latter,  also,  wakefulness  or  restlessness  is  frequently  an 
evidence  of  overfeeding. 

The  observant  mother  may  soon  learn  quite  a  little  from 
the  baby's  cry.  She  will  distinguish  the  "worrying"  cry 
of  discomfort,  sleepiness,  or  fatigue,  the  loud  outcry  with 
squirming  or  drawing  of  the  low^er  limbs,  which  is  indicative 
of  abdominal  pain  of  some  sort— colic,  perhaps,  or  discom- 
fort in  the  urinary  passages.  Later,  also,  the  explosive  cry 
of  fright  or  anger.  The  various  sick  cries  may  be  distin- 
guished, but  are  often  deceptive.  Thus,  crying  after  cough- 
ing is  usually  interpreted  as  meaning  thoracic  sensitiveness, 
while  the  child  with  pneumonia  generally  saves  his  breath 
and  can  rarely  spare  it  for  outcries.  But  there  are  excep- 
tions. The  hoarse  cry  of  croup  can  only  be  referred  to  the 
right  place— the  larynx. 

UNSUCCESSFUL   SUCKLING 

Returning  to  the  matter  of  suckling,  the  following  is  to  be 
noted :  If  there  be  a  doubt  about  the  need  of  supplementary 
food,  the  painstaking  physician  will  be  the  best  adviser.  He 
will  often  easily  point  out  errors  in  the  maternal  hygiene  or 


36  THE  CENTURY  BOOK  FOR  MOTHERS 

in  the  infant's  regimen  which  have,  not  unnaturally,  escaped 
the  mother's  notice.  One  of  the  commonest  errors  noted  in 
the  stress  of  modern  life  is  this :  The  function  of  suckling  is 
a  natural  one,  and  as  such  is  not  exhausting.  But  in  order 
that  any  natural  function  be  properly  performed,  the  life 
must  be  a  natural  one.  Whenever  the  so-called  "social 
duties"  take  precedence,  in  fact  or  in  desire,  of  the  maternal 
ones  the  nutrition  of  the  infant  is  threatened.  It  is  true 
that  many  children  are  unwelcome  guests,  and  the  usual  re- 
straints which  pregnancy  puts  upon  social  activity  are  un- 
graciously borne.  In  such  cases,  though  the  further  re- 
straints entailed  by  suckling  are  very  likely  resented,  the 
nursing,  if  performed  at  all,  is  done  under  such  conditions 
as  to  make  it  of  doubtful  value.  But  we  often  see  women 
who  have  gladly  become  mothers,  and  w^ho  desire  to  do 
their  duty  to  their  children,  undertake  suckling  under  cir- 
cumstances sure  to  entail  failure.  How  often  do  we  see  a 
mother  successfully  suckle  the  little  one  until  she  begins  to 
take  up  her  former  social  life.  When  the  baby's  afternoon 
nursing  is  hurried,  in  order  that  the  mother  may  pour  tea 
at  Mrs.  Blank's,  which  she  does  under  a  worrying  conscious- 
ness that  the  baby's  next  meal  will  be  overdue  before  she 
gets  home,  the  nursing-bottle  and  its  accompaniments  are  not 
far  off. 

But  the  most  devoted  mother,  in  otherwise  good  health, 
may  be  defeated  in  her  attempts  to  suckle  her  babe  by  some 
apparently  slight  matter.  One  of  the  commonest  is  tender, 
irritated,  or  cracked  nipples.  Sometimes  the  pain  of  each 
nursing  is  such  as  to  draw  tears  to  the  mother's  eyes  or  to 
make  her  faint,  and  the  frequent  repetition  of  the  suffering 
may  so  exhaust  her  that  the  breast  milk  is  no  longer  suffi- 
cient. In  the  chapter  on  ' '  The  Preparation  for  Motherhood ' ' 
some  suggestions  regarding  the  care  of  the  nipple  were  made, 
and  the  same  are  still  of  value  after  delivery. 

After  each  suckling  the  nipple  should  be  washed  with 
warm  water,  and  afterward  with  a  boric-acid  solution  if 
there  is  any  irritation.  Then  it  should  be  most  carefully 
dried.     These  precautions  are  preventive,  and  to  be  used 


NURSERY  ROUTINE  37 

even  in  a  perfectly  healthy  state  of  the  nipples.  As  the 
nipple  and  the  baby's  mouth  are  so  intimately  in  contact, 
and  affections  of  one  may  spread  to  the  other,  the  latter 
should  also  be  cleansed  in  the  same  manner  after  each  suck- 
ling. If  the  nipples  be  very  tender  it  is  wise  to  protect  them 
at  the  time  of  suckling  with  the  well-known  nipple  shield, 
which  is  essentially  a  glass  dome  covering  the  nipple  and 
the  neighboring  part  of  the  breast  so  that  the  tender  parts 
are  not  irritated  by  the  contact  of  the  baby 's  mouth,  while  a 
rubber  nipple  at  the  summit  permits  the  sucking  to  be  done. 
For  actual  cracks  of  the  nipples,  various  applications  are 
made.  Of  these,  some  previously  mentioned  may  be  em- 
ployed. In  severe  or  obstinate  cases  it  is  better  to  consult 
the  physician,  who  will  make  more  efficient  ones.  But  the 
treatment  of  a  cracked  nipple  which  has  been  well  established 
is  tedious  and  often  results  in  the  abandonment  of  the  use 
of  that  breast. 

THE   MOTHER'S   DIET 

The  diet  of  the  nursing  mother  should  be  ample  and  digest- 
ible. But  it  should  be  varied.  While  it  is  probably  true  that 
some  kinds  of  food  may  affect  the  taste  of  the  mother 's  milk, 
this  fact  should  not  be  allowed  to  limit  her  choice  too  much. 
On  the  other  hand,  she  should  not  fall  into  the  error  of  over- 
feeding. The  amount  of  proteids  in  the  diet  governs  largely 
the  amount  of  the  same  and  of  fat  in  the  milk,  and  an  unusu- 
ally rich  dietary  may  do  harm  as  well  as  an  unusually  poor 
one.  Beside  the  usual  varied  table  diet,  adjusted  to  the  di- 
gestive peculiarities  of  the  individual,  milk  may  be  used  as 
a  ready  method  of  obtaining  all  those  elements  which  are 
to  be  reproduced  in  the  mother's  milk.  It  may  be  taken 
between  meals  and  at  bedtime  most  advantageously,  and  it 
should  be  kept  in  mind  that  it  is  a  food,  not  a  simple  bev- 
erage. The  writer  has  never  been  able  to  see  that  any  real 
gain  came  from  the  use  of  beer  or  alcoholic  beverages,  except 
occasionally  to  increase  the  appetite.  Some  good  observers, 
however,  hold  a  different  opinion. 

Among  the  conditions  affecting  the  composition  of  the 


38  THE  CENTURY  BOOK  FOR  MOTHERS 

mother's  milk  may  be  mentioned  emotional  disturbances  and 
menstruation.  Emotional  women  do  not  make  the  best 
nurses,  and  it  is  a  matter  of  common  observation  that  strong 
emotions,  probably  anger  most  of  all,  are  likely  to  be  fol- 
lowed by  disturbances  in  the  child.  A  wilful  or  unrestrained 
woman  should  never  be  employed  as  a  wet-nurse,  and  it  is 
doubtful  whether  a  mother  of  such  temperament  is  prefer- 
able to  bottle-feeding.  It  would  not  be  even  advisable  if  it 
were  certain  that  such  a  mother  w^ould  be  any  more  careful 
of  the  food  than  of  her  temper. 

The  effect  of  menstruation  upon  the  quality  of  the  milk 
is  sometimes  marked,  but  experience  differs  as  to  the  fre- 
quency Avith  which  this  effect  is  noticeable.  The  writer's 
experience  is  that  the  effect  is  generally  not  great,  except 
when  the  menstruation  begins  at  a  time  rather  late  in  the 
nursing  period,  in  which  case  it  is  rather  a  signal  that  the 
activity  of  the  breasts  is  becoming  subordinate  than  a  dis- 
turber of  the  condition  of  the  child.  It  is  then  a  hint  that 
supplementary  feeding  is  called  for.  When  menstruation 
occurs  early  in  lactation  the  baby's  condition,  especially  as 
regards  the  bowels,  should  be  watched.  The  child  probabty 
need  not  be  taken  from  the  breast,  or  if  so  only  for  a  few 
days. 

BATHING 

The  directions  as  to  the  bath  routine,  given  on  page  27,  will 
hold  good  for  a  child  of  average  strength  until  it  is  about  six 
months  old,  when  the  temperature  may  be  dropped  a  few  de- 
grees and  thereafter  a  degree  or  two  from  time  to  time,  so  that 
a  child  of  good  physique  a  year  old  will  probably  react  well 
from  a  dip  into  a  bath  as  low  as  90°  F.  But  the  blunder 
of  ''hardening"  by  too  rapid  change  should  not  be  com- 
mitted. As  children  increase  in  age  the  bath  may  be  changed 
in  character,  rather  than  in  temperature — that  is  to  say,  a 
young  child  cannot  well  bear  immersion,  at  least  for  more 
than  a  few  seconds,  in  water  much  below  90°  F.  The  sur- 
face of  a  little  child's  body  is  very  large  in  proportion  to 


I 


NURSERY  ROUTINE  39 

its  mass  if  compared  with  that  of  an  adult.  This  fact  and 
the  susceptibility  of  its  nervous  system  doubtless  account  for 
the  ease  with  which  a  child  is  depressed.  On  the  other  hand, 
the  stimulating  effect  of  a  slight,  cool  sponging  upon  a 
healthy  child  is  undoubted.  Hence  it  has  been  a  standard 
practice  to  let  the  child  stand  ankle-deep  in  warm  or  tepid 
water  while  it  is  quickly  sponged  over  with  water  of,  say, 
70°  F.,  or  even  cooler  in  some  cases.  But  it  should  be  borne 
in  mind  that  for  feeble  children  or  for  those  not  evidently 
feeble  who  do  not  react  well  from  any  chill  or  cool  bathing 
great  care  in  this  direction  is  to  be  exercised.  When  borne 
well,  the  cold  sponging  alluded  to  is  especially  useful  about 
the  throat,  neck,  breast,  and  shoulders  as  a  safeguard  against 
the  common  tendency  to  'Hake  cold." 

Although  the  question  of  sea  bathing  is  not  one  that  con- 
cerns infancy,  it  may  as  well  be  mentioned  in  connection 
with  bathing  in  general.  Bathing  in  salt  Avater  may  begin 
at  about  three  years  of  age,  provided  the  water  be  warm  and 
quiet.  Under  no  circumstances  should  a  child  be  taken  into 
the  water  or  be  romped  with  there  in  any  way  likely  to 
alarm  it.  The  beginning  may  be  made  on  a  warm  day,  the 
child  being  allowed  to  play  alone  in  the  shallow  water  or 
being  carried  in  the  arms  of  an  adult.  This  '^ paddling," 
however,  must  be  watched,  because  it  is  harmless  only  so  long 
as  the  child  is  kept  warm  by  activity.  Any  dawdling  with 
the  feet  in  the  relatively  cool  sea-water  is  not  permissible  for 
a  small  child.  Gradually,  as  strength  and  courage  increase, 
the  child  may  venture  farther  and  remain  in  longer,  and 
essays  at  swimming  be  made.  Real  sea  bathing— that  is, 
bathing  in  the  open  ocean  or  in  the  surf— is  not  a  child's 
play  at  all.  The  shock  is  very  considerable  even  in  quiet 
weather,  and  only  older,  adolescent  children  should  be  al- 
lowed to  indulge  in  it,  except  under  the  careful  supervision 
of  an  adult.  The  test  of  suitability  in  sea  bathing,  as  in  any 
cold  bathing,  is  the  promptness  and  completeness  of  the  reac- 
tion. If  there  is  any  chilliness  remaining  after  the  rub 
down,  the  bathing  is  probably  harmful. 


BABY^S  AIRING  AND   EXERCISE 

ANEW  infant  cannot  be  said  to  need  exercise  in  the  ordi- 
.  nary  sense.  Its  rapid  growth  and  development  demand 
the  abundance  of  food  it  ingests.  There  is  no  need  for  mus- 
cular activity,  as  would  be  the  case  with  an  adult,  or  even 
with  an  older  child  eating  anything  like  such  a  proportion  of 
its  own  weight  daily.  Fresh  air,  however,  is  advantageous 
to  the  infant,  provided  it  can  be  had  without  exposure.  In 
warm  weather  the  child  may  be  taken  out  of  doors,  in  places 
sheltered  from  wind  or  too  strong  sun,  very  early  in  its  life. 
In  cold  weather  this  going  out  must  be  postponed  in  pro- 
portion to  the  lowness  of  the  temperature  and  the  feebleness 
of  the  child.  When  first  taken  out,  especially  in  cool 
weather,  the  child  should  be  carried  in  arms.  It  needs  the 
warmth  of  the  attendant's  person,  the  support  of  her  arms, 
and  it  is  safer  from  jolts  than  it  would  be  in  a  baby-carriage. 
In  thus  carrying  a  child  it  should  never  be  forgotten  that  it 
is  taken  out  for  its  benefit,  not  for  admiration.  Its  long 
garments  and  wraps  should  be  kept  closely  about  it,  and  the 
habit,  less  frequently  seen  than  formerly,  of  supporting  the 
infant  in  such  a  waj^  that  one  hand  or  arm  is  within  its 
wraps,  permitting  the  latter  to  fall  gracefully  and  display 
its  embroidery,  need  only  be  recalled  to  be  reprobated. 

THE   BABY-CARRIAGE 

AVhen  a  child  is  taken  out  in  its  carriage  its  protection 
should  be  in  accordance  with  the  demands  of  the  tempera- 
ture.    If  this  be  low,  an  abundance  of  light,  warm  wraps, 

40 


BABY'S  AIRING  AND  EXERCISE  41 

with  a  foot- warmer  of  some  description  within,  will  be  called 
for.  The  carriage  for  infants  itself  requires  a  hood  or 
chaise-top  for  protection  both  from  sun  and  wind.  It  may 
be  doubted  if  a  day  so  damp  or  so  windy  as  to  call  for  a 
veil  is  a  suitable  day  for  the  infant  to  be  abroad.  On  such 
days  probably  greater  advantage  is  gained  from  the  placing 
of  the  carriage,  with  the  child,  in  a  sunny,  well-aired,  and 
unwarmed  room  than  in  taking  it  out  of  doors  at  all.  And 
this  hint  will  serve  for  older  children,  especially  in  cities, 
where,  if  they  go  out,  they  must  walk  near  gutters  in  drafty 
streets.  The  whole  question  is  not  of  outdoors  or  indoors, 
but,  Where  can  the  most  sunshine  and  sweet  air  be  had? 

The  carriage  should  have  easy  springs,  so  that  the  child  is 
not  harshly  jolted  by  inequalities  of  the  surface.  It  should 
have  a  comfortable  mattress,  and  a  pillow  suitable  to  the  size 
of  the  child,  supporting  its  head  without  bowing  the  shoul- 
ders. It  should  have  a  strap  or  some  contrivance  to  prevent 
an  active  infant  from  throwing  itself  out  of  the  vehicle  or 
being  thrown  out  by  any  accident.  In  wheeling  a  baby- 
carriage  attention  should  be  given  to  its  course,  as  a  small 
stone  is  a  serious  obstacle  to  so  small  a  vehicle,  and  a  curb- 
stone becomes  a  precipice.  The  eyes  of  the  little  one 
should  not  be  exposed  to  the  strong  sun  while  it  lies  upon 
its  back.  The  hood  can  be  so  tilted  as  to  shade  the  face, 
while  the  sun- warmed  air  permeates  the  whole  vehicle. 

EXERCISE   FOR   OLDER  CHILDREN 

As  the  infant  becomes  stronger  it  takes  its  exercise  by  kick- 
ing, learning  the  use  of  its  hands  and  members,  later  by  sit- 
ting up,  then  by  creeping,  learning  to  stand,  to  balance,  and 
later  to  walk.  Sitting  alone  probably  will  come  at  about 
six  months  of  age;  walking  alone  at  from  twelve  to  fifteen 
months.  Unless  the  child  is  exceptionally  dull  in  mind,  do 
not  urge  it  to  make  advances.  As  it  feels  its  power  it  will 
try  all  these  new  acquirements  and  make  gains  more  or  less 
rapidly,  according  to  its  ability  and  natural  gifts.     Like- 


42        THE  CENTURY  BOOK  FOR  MOTHERS 

wise,  be  always  gentle  in  playing  with  a  baby.  Hard  trot- 
ting, tossing,  and  other  horse-play  is  undesirable  and  in- 
judicious. 

Exercise  for  its  own  sake  is  the  result  of  a  high  artificializ- 
ing  of  life.  Wild  animals  get  enough  of  exercise  in  the  search 
for  food.  Man,  either  in  the  wild  or  civilized  state,  so  long 
as  his  occupation  is  one  of  physical  exertion,  usually  gets 
enough,  and  at  most  needs  some  change  of  occupation  or 
exertion  when  his  usual  one  is  too  highly  specialized  as  to 
the  muscles  employed.  So  with  children  in  any  surround- 
ing where  the  natural  admixture  of  outdoor  play  and  of 
assisting  in  family  cares  and  duties  according  to  the  strength 
of  each  exists. 

When,  however,  a  child  is  so  situated  in  life  that  every- 
thing is  done  for  it  except  the  chewing  of  its  own  food ;  when 
outdoor  life  is  restricted  to  a  joyless  walk  with  a  nurse,  and 
much  of  its  time  must  be  spent  in  the  schoolroom,  the  watch- 
ful parent  is  obliged  to  invent  or  seek  out  forms  of  exercise. 
For  the  country  child,  walking,  climbing,  rowing,  fishing, 
hunting,  and  the  numberless  games  of  summer-time ;  skating 
and  coasting  and  the  like  in  winter,  are  enough.  For  the 
town  child  some  of  these  are  still  available.  But  as  the 
city  is  transformed  into  the  great  city,  the  distance  from 
the  home  to  the  place  of  play  or  exercise  becomes  greater 
and  greater,  and  all  the  available  time  is  given  to  the  going 
and  coming.  Hence  the  growing  need  of  parks,  not  only  as 
places  of  display,  but  of  exercise  and  recreation ;  the  call 
for  gymnasia  for  the  older  children,  calisthenic  classes  for 
the  younger,  where  the  advantages  of  the  exercise  per  se  are 
much  increased  by  the  learning  to  do  things  systematically 
and  in  cooperation.  These  are  especially  desirable  for  the 
feeble  child,  who  lacks  the  impulse,  and  for  the  phlegmatic 
or  indolent  child  who  shrinks  from  exertion.  The  gymna- 
sium, of  course,  presupposes  a  judicious  teacher  who  will 
guide,  stimulate,  or  check  as  each  child  needs.  If  no  gymna- 
sium be  available,  the  parent  should  choose  the  exercise  as 
far  as  practicable,  not  from  the  fads  of  the  moment,  but 


BABY'S  AIRING  AND  EXERCISE  43 

with  regard  to  the  needs  of  the  child  and  its  strength,  age, 
and  development,  and  should  see  that  no  amusements  be  in- 
dulged in  which  are  harmful  bodily  or  mentally,  and,  as 
adolescence  is  reached,  try  to  prevent  overdoing  in  competi- 
tive games.  It  hardly  need  be  said  at  the  present  day  that 
up  to  puberty  a  girl  should  have  the  same  freedom  of  exer- 
cise as  a  boy,  and  at  and  after  puberty  she  need  be  restrained 
only  as  special  occasion  occurs,  although  she  should  no  longer 
put  her  strength  against  that  of  the  adolescent  boy. 


VI 
DRESS   AND  CLOTHING 

THE  first  clothing  for  a  child  is,  of  course,  prepared  in 
advance  of  its  birth,  and  might  have  been  considered  in 
connection  with  the  preparations  for  maternity.  It  seems 
preferable,  however,  to  make  it  a  part  of  the  general  treat- 
ment of  the  subject  of  dress. 

While  dress  varies  very  much  in  different  countries,  cer- 
tain peculiarities  are  so  uniform  in  all  as  to  merit  considera- 
tion as  general  principles,  although  the  applications  must 
accord  with  the  demands  of  climate  and  external  conditions 
of  all  sorts.  These  general  principles  are,  first,  that  the 
protection  against  cold  must  be  adequate  to  conserve  heat 
within  the  limits  of  the  person's  producing  power.  In  hot 
climates,  of  course,  this  conservation  is  hardly  called  for,  and 
protection  from  the  sun  and  the  demands  of  decency  are  the 
essential  factors.  Second,  that  the  protection  shall  be  as 
nearly  uniform  over  the  person  as  practicable,  some  extra 
safeguarding  being  generally  given  to  the  cavities  of  the 
trunk.  Lastly,  that  the  clothing  shall  be  as  unrestraining  as 
to  the  motions  and  the  functions  of  the  body  and  as  little 
burdensome  as  possible.  Still  further  may  be  added  the 
subordinate  qualifications  of  unirritating  surface  and  es- 
thetic appearance. 

These  requirements  have  been  put  in  the  order  of  impor- 
tance as  they  apply  to  infants'  clothing.  It  is  to  be  re- 
gretted that  the  order  is  often  reversed  in  practice.  The 
requirements  of  protection  and  want  of  burdensomeness  are 
best  met  by  garments  of  soft,  porous  texture,  as  such  are 

44 


DRESS  AND  CLOTHING  45 

poorer  conductors  of  heat  than  others  and  best  conserve  the 
body  warmth,  while  they  are  permeable  to  the  body 's  exhala- 
tions. The  universal  experience,  where  choice  exists,  is  that 
garments  of  wool  have  the  desired  combination  of  these  quali- 
ties in  the  highest  degree.  If  there  is  no  unusual  sensitive- 
ness of  the  infant's  skin,  that  garment,  at  least,  which  is 
next  the  skin  should  be  of  a  soft  woolen  fabric  of  such  tex- 
ture that  it  is  freely  elastic  and  unirritating  to  the  skin. 
Machine-  or  hand-knitted  fabrics  perhaps  most  perfectly  ful- 
fil the  requirement.  For  sensitive  skins  or  in  those  climates 
where  woolen  garments  are  unsuitable,  soft  cotton  fabrics, 
or  knitted  silks  if  the  purse  permits,  must  be  used  instead. 
It  may  be  well  to  know  that  the  element  of  non-conducting 
power  may  be  gained,  even  in  fabrics  not  otherwise  the  best, 
by  increasing  the  number  of  layers.  Thus  two  or  three  thin 
undershirts,  one  over  the  other,  are  often  better  protection 
than  one  shirt  as  heavy  as  their  united  weight  and  of  the 
same  weave. 

The  greatest  objection  to  fabrics  of  all  wool  is  the  remark- 
able shrinkage  which  occurs  in  washing  by  any  but  the  most 
expert  hands.  Properly  washed,  they  may  last  a  long  time ; 
but  the  writer  has  frequently  seen  loose,  all-wool  outing 
shirts  shrunken  by  a  laundry  beyond  the  possibility  of  wear- 
ing in  three  washings.  This  has  led  to  a  great  variety  of 
devices,  the  ordinary  one  being  to  mix  enough  cotton  with 
the  wool  so  that  it  will  not  shrink  inordinately,  while  pre- 
serving a  large  part  of  its  warmth.  Such  goods  are  gener- 
ally called  merino,  the  proportion  of  cotton  varying  greatly. 
Another  combination  was  that  in  which  a  wool  face  or  pile 
was  incorporated  with  a  cotton-web  backing,  the  former  giv- 
ing warmth,  while  the  latter  resisted  the  shrinkage. 


THE   PRINCIPAL   REQUIREMENTS   IN   DRESS 

All  infant  garments  should  be  very  free  and  loose-fitting, 
no  constricting  bands  or  parts  being  permitted  anywhere. 
In  detail,  the  garments  are  usually  the  following: 


46  THE  CENTURY  BOOK  FOR  MOTHERS 

First  a  girdle,  called  the  binder  or  band,  the  first  use  of 
which  is  to  retain  the  dressings  of  the  cord  and  to  protect 
the  unhealed  umbilicus  from  injury.  After  the  healing  of 
the  navel  it  is  of  doubtful  benefit,  since  its  name  seems  to 
suggest  to  the  nurse  or  mother  that  it  ought  to  bind,  or  be 
tight,  which  it  should  never  do.  There  was  a  notion,  which 
may  still  survive,  that  a  tight  bandage  would  prevent  rup- 
ture. This  was  a  blunder.  It  did  not  prevent  abdominal 
or  navel  hernia,  and  by  increasing  the  strain  lower  down  it 
favored  groin  hernia.  If,  however,  it  be  remembered  that 
the  band  is  simply  for  warmth  and  not  for  support,  and 
that  it  should  be  loose,  it  may  be  advantageous.  Unless  it  be 
made  with  shoulder-straps  or  some  appliance  to  keep  it  in 
place,  it  is  likely  to  slide  about  unless  too  tightly  pinned. 
The  Avriter,  therefore,  prefers  a  shirt.  If  the  band  be  used, 
it  should  be  of  flannel  or  knitted,  and  should  reach  from  the 
breast  to  the  napkin.  But  the  shirt  has  all  its  advantages, 
and  is  not  likely  to  be  too  tight.  In  fact,  many  so-called 
binders,  with  shoulder-straps  and  a  pinning-tab  for  fasten- 
ing to  the  napkins,  are  really  only  sleeveless  shirts. 

THE   NAPKINS 

The  other  garment  going  next  to  the  skin  is  the  napkin. 
It  is  rather  a  misnomer  to  call  it  a  garment,  as,  while  it  is  a 
covering  and  a  protection,  it  would  probably  never  be  used 
save  to  protect  the  other  garments  from  being  soiled  by  the 
urine  and  evacuations  from  the  bowels.  But  its  contact 
with  the  skin  requires  that  it  be  treated  as  a  garment.  The 
best  material  for  napkins,  or  at  least  for  inner  napkins, 
is  old  linen  of  heavy  weight,  old  table-linen  cut  up  being  the 
most  desirable.  But  as  the  supply  of  this,  unless  one  can 
buy  it  from  a  hotel,  is  very  inadequate,  most  of  the  supply 
must  be  bought ;  and  at  the  present  time  we  think  the  mate- 
rial known  as  cotton  bird's-eye  is  generally  preferred,  most 
new  linen  being  too  stiff  for  the  purpose.  It  may,  how- 
ever, be  used  at  first  for  outer  napkins,  and  as  these  soften 


DRESS  AND  CLOTHING  47 

by  repeated  washings  they  may  be  used  as  inner  napkins. 
Cheese-cloth  of  rather  close  weave  may  be  used,  and  is 
sometimes  cheaper  than  the  washing  of  other  fabrics,  the 
cheese-cloth  being  used  but  once.  This  material  is  espe- 
cially applicable  for  the  inner  napkins.  The  napkins  must 
be  so  large  that  a  diagonal  of  the  square  wall  reach  around 
the  infant's  hips  and  pin  easily.  They  are  sometimes 
made  square,  sometimes  twice  as  long  as  wide,  and  are 
folded  once  to  make  a  square.  When  applied  the  square  is 
folded  diagonally,  which  will  make  four  thicknesses.  The 
diagonal  edge  is  put  about  the  infant's  waist,  and  the  other 
angle  of  the  triangle  is  brought  up  between  the  thighs  to 
meet  the  other  ends.  When  an  inner  napkin  is  used,  the 
outer  napkin  does  not  really  need  to  be  two  squares  long, 
two  thicknesses,  when  the  napkin  is  folded  on  the  diagonal, 
being  bulky  enough.  Whatever  shape  is  used,  the  napkin  is 
to  be  hemmed.  The  size  is  usually  half  a  yard  on  a  side 
for  new  babies,  and  larger  as  the  baby  grows.  If  the  double- 
length  napkin  be  used,  it  is,  of  course,  a  yard  long  at  first, 
and  later  double  the  increased  width  is  called  for.  The 
inner  napkin  is  sometimes  simply  another  napkin  like  the 
first.  Preferably  it  is  one  of  soft  material,  about  two 
feet  square,  which  is  folded  once  each  way,  making  a  square 
of  four  thicknesses  about  one  foot  on  each  side.  This  is 
laid  over  the  larger  triangle,  one  corner  corresponding  with 
the  lower  angle  of  the  outer  napkin  in  such  a  manner  that 
the  smaller  one  will  cover  the  buttocks  and  genitals.  The 
smaller  napkin  gives  all  necessary  protection  against  wet- 
ting, and  is  retained  by  the  larger  triangle. 

The  care  of  napkins  deserves  a  word,  and  really  but  a 
word,  which  is  that  a  napkin  should  be  changed  as  soon  as 
it  is  known  to  be  wet,  and  should  not  be  used  again,  how- 
ever little  it  has  been  wet,  unless  it  has  been  rinsed  out  in 
clean  water.  Of  course,  soiled  napkins  must  be  thoroughly 
washed.  Objection  is  often  made  to  this  simple  rule  that  it 
gives  too  much  trouble;  that  napkins  merely  wet  may  be 
simply  dried,  and  used  again  without  harm.     The  answer  is 


48  THE  CENTURY  BOOK  FOR  MOTHERS 

that  there  is  no  easy  road  to  success  in  child-rearing  any 
more  than  in  anything  else.  If  a  mother  is  so  burdened 
with  cares  and  duties  that  the  rule  cannot  be  complied  with, 
she  must  keep  the  rule  in  mind  and  do  her  best.  As  to  the 
using  again  of  unwashed  napkins  and  their  doing  no  harm, 
it  may  be  admitted  that  some  skins  do  not  seem  to  be  irri- 
tated immediately  by  the  practice ;  but  this  is  not  proof  that 
it  is  harmless,  and  in  any  case  such  a  procedure  is  contrary 
to  all  notions  of  propriety. 

One  thing  should  be  mentioned  only  for  condemnation— 
the  india-rubber  diaper,  or  one  of  any  water-proof  material. 
It  is  hard  to  imagine  how  any  one  could  have  devised  the 
plan  of  poulticing  an  infant's  skin  with  its  own  fermenting 
excretions.  They  are  always  foul-smelling  things,  and  some- 
times produce  grave  excoriations  or  ulceration  of  the  skin. 
If  any  emergency,  like  traveling,  demands  unusual  protec- 
tion from  moisture,  it  should  be  met  by  an  unusual  amount 
of  absorbent  material,  such  as  extra  napkins  or  absorbent 
cotton,  which  may  be  thrown  away,  rather  than  any  imper- 
vious covering  to  confine  the  urine  about  the  child. 

The  consideration  of  napkins  calls  for  mention  of  their 
discontinuance.  Of  course,  infants  must  be  protected  until 
they  can  be  taught  to  give  notice  of  their  wants  or  to  relieve 
themselves  with  sufficient  regularity  to  prevent  the  danger 
of  untimely  wettings  or  soilings.  Just  at  what  age  this  can 
be  done  cannot  be  said,  as  it  varies.  Disregarding  cases  in 
which  the  child  has  abnormal  inability  to  control  the  flow  of 
urine,  as  in  many  cases  of  bed-wetting,  it  is  probable  that 
most  children  wear  napkins  longer  than  is  really  necessary. 
In  fact,  our  English  cousins  believe  that  the  American  child 
is  allowed  to  depend  upon  them  much  longer  than  do  their 
babies.  They  claim,  moreover,  that  while  the  infant  is  still 
but  a  few  months  old  it  can,  by  the  regular  holding  it  over 
a  small  nursery  vessel,  associate  in  its  mind  the  presence  of 
the  vessel  with  the  act  of  emptying  its  bladder  or  its  bowels. 
The  plan  is  certainly  worth  trying  in  all  cases,  since  if  it 
fails  nothing  is  lost,  and  if  successful  the  child  and  its  atten- 


DRESS  AND  CLOTHING  49 

dants  are  relieved  from  what  it  is  not  too  much,  in  many 
cases  at  least,  to  call  the  bondage  of  the  napkin,  as  well  as 
from  the  various  irritations  and  annoyances  which  arise 
from  their  unduly  prolonged  use. 

SOCKS 

The  one  article  of  apparel  which  the  new  baby  is  sure  to 
find  itself  abundantly  provided  with  in  advance  is  socks, 
generally  in  great  variety  of  color,  pattern,  and  material. 
They  are  unobjectionable  if  big  enough,  but  are  really  of 
little  use,  if  indeed  of  any,  while  the  long  clothes  are  worn, 
and  are  not  comparable  for  protection  to  warm  stockings 
after  the  clothes  are  shortened.  While  long  clothes  are  worn 
it  is  just  as  well  to  let  the  infant  have  the  unrestrained  free- 
dom of  its  feet  and  its  fascinating  pink  toes. 

This  is  in  no  wise  to  be  construed  as  indorsing  the  expo- 
sure of  the  feet  or  limbs.  If  the  "hardening"  is  ever  men- 
tioned it  should  be  for  condemnation.  The  feet  are  to  be 
always  kept  warm,  but  the  free  wrapping  of  the  flannel  petti- 
coat or  the  more  complete  protection  of  the  stocking  seems 
better.  Whether  or  not  the  feet  need  covering  during  toilet 
depends  upon  the  warmth  of  the  apartment.  In  a  general 
way  we  should  say  that  an  infant  should  never  be  washed 
or  dressed  or  changed  in  a  room  at  so  low  a  temperature  as 
could  make  the  feet  cold.  But  if  the  climate  or  the  construc- 
tion of  the  house  is  such  that  it  becomes  cold  at  night,  a  pair 
of  extra  wide  and  loose  stockings  which  can  be  slipped  on 
the  baby  with  ease,  much  as  the  mother  puts  on  her  "bed- 
room slippers, ' '  mil  be  found  convenient  when  the  necessary 
changings  must  be  done. 

These  three  articles— the  band  or  shirt,  the  napkin,  and 
the  stocking,  if  used— constitute  the  immediate  body  rai- 
ment. Outside  of  this  a  variety  of  apparel  within  rather 
narrow  limits  may  be  used.  The  principle  of  uniform  pro- 
tection and  freedom  of  motion  should  apply  to  whatever  is 
selected. 

4 


50  THE  CENTURY  BOOK  FOR  MOTHERS 

OLD-FASHIONED   CLOTHING 

The  traditional  baby  clothes,  with  the  '' pinning  blanket 
or  '^barry  coat,"  its  petticoats  with  waists,  and  its  dress, 
last  of  all,  had  really  only  this  to  recommend  them  from  a 
hygienic  point  of  view :  they  protected  the  infant  from  cold. 
Tradition  only  kept  and  still  keeps  them  in  use.  The  waists 
had  to  be  made  to  fold  over,  as  they  could  not  be  made  to 
fit  a  chest  at  first  of  unknown  and  then  of  constantly  chang- 
ing dimensions.  They  had  to  be  pinned  or  sewed  to  be  kept 
in  place,  and  the  result  was  a  tight  binder  about  the  thorax, 
which  is  at  least  as  objectionable  as  one  about  the  abdomen. 
Besides  the  harm  of  this  compression  of  the  ribs,  the  inelastic 
waists  are  uncomfortable,  and  the  putting  on  of  the  suit, 
with  its  constant  rolling  of  the  infant  from  breast  to  back, 
reminds  a  masculine  bystander  of  nothing  so  much  as  the 
stropping  of  a  razor.  And  at  the  end  of  the  performance 
the  infant's  patience  is  usually  quite  exhausted,  and  it 
shows  it. 

THE   "GERTRUDE"   SUIT 

Fortunately,  better  styles  of  dressing  can  be  had. 

Starting  with  the  shirt  or  loose  binder  and  the  napkin, 
which  make  the  indispensable  body  protection,  and  the  stock- 
ings (if  used) ,  one  good  warm  layer,  such  as  is  gotten  from  a 
flannel  garment  reaching  from  neck  to  eight  or  ten  inches 
below  the  infant's  feet— a  slip,  in  other  words— would  con- 
stitute in  most  climates  all  the  protection,  beyond  shawls  and 
cradle  wraps,  that  the  physical  needs  of  the  child  demand. 
But  it  is  convenient  to  have  further  protections,  so  that,  as 
it  gains  power  of  movement,  it  may  not  displace  its  covering 
and  may  still  be  warm  enough.  It  is  also  convenient  to  have 
an  easily  changed  covering  to  keep  the  warm  garment  clean ; 
and,  above  all,  the  mother's  taste  demands  something  which 
shall  make  the  infant  an  attractive  object,  if  not  a  thing  of 
beauty,  to  others  as  well  as  to  herself. 

One  of  the  first  suits  to  attract  attention,  which  was  made 


DRESS  AND  CLOTHING  51 

in  accordance  with  hygienic  needs,  was  the  ' '  Gertrude ' '  suit, 
devised  by  Dr.  L.  C.  Grosvenor,  of  Chicago,  and  named  after 
his  infant  daughter,  for  whose  comfort  it  was  originally 
devised.  Its  convenience  was  so  manifest  that  the  demands 
for  patterns  obliged  Dr.  Grosvenor  to  make  them  public. 
In  1886  his  articles  were  republished  in  ''Babyhood,"  and 
the  suit  recommended  as  the  best  then  within  the  knowledge 
of  the  present  writer.  As  there  described  the  suit  con- 
sisted of 

1.  The  Dress,  which,  being  external,  could  be  of  any  pat- 
tern to  suit  the  taste,  but  the  recommended  one  was  a  plain 
slip. 

2.  The  Undershirt  and  Nightgown.— These  were  alike. 
' '  The  best  material, ' '  wrote  Dr.  Grosvenor,  ' '  is  Canton  flan- 
nel of  medium  weight.  The  hem  of  the  neck,  wrist,  and 
bottom  is  turned  over  on  the  outside  and  catstitched,  so  that 
there  shall  be  nothing  rough  on  the  inside.  Hems  are  con- 
cealed by  a  simple  trimming.  The  nightgown  and  diaper 
are  all  that  are  needed  for  night  wear." 

3.  The  Flannel  Shirt.— "Made  of  woolen  flannel,  with- 
out sleeves,  the  armholes  and  neck  being  scalloped,  but  not 
bound.     May  be  as  ornamental  about  the  bottom  as  desired. ' ' 

4.  The  Diapers.— "  Cotton  flannel  is  recommended,  as  being 
softer,  warmer,  and  more  absorbent  than  linen  or  any  other 
material.  The  hem  is  turned  over  on  the  right  side  and  run 
through  the  machine.     Use  the  fleecy  side  next  to  the  baby." 

Concerning  the  suit  in  general.  Dr.  Grosvenor  wrote :  ' '  The 
undergarment  should  be  made  of  nice,  fleecy  goods— Can- 
ton flannel  is  the  best  we  have  at  present— cut  princess, 
reaching  from  the  neck  to  ten  inches  (twenty-five  inches 
long)  below  the  feet,  with  sleeves  to  the  wrists,  and  hav- 
ing all  the  seams  smooth  and  the  hems  at  neck,  wrist,  and 
bottom  upon  the  outside— the  latter  turned  over  once  and 
felled  or  catstitched  with  colored  worsted— a  tie  and  a  but- 
ton behind.  Here  you  have  a  complete,  fleece-lined  gar- 
ment, comfortable  and  healthy,  and  one  that  can  be  washed 


52        THE  CENTURY  BOOK  FOR  MOTHERS 

without  shrinking.  The  next  garment  is  made  of  baby- 
flannel  (woolen),  also  cut  princess,  same  pattern,  only  one- 
half  inch  larger,  reaching  from  the  neck  to  twelve  or  four- 
teen inches  below  the  feet— to  cover  the  other— with  gen- 
erous armholes  pinked  or  scalloped,  but  not  bound,  with 
two  buttons  behind  at  the  neck,  and  may  be  embroidered  at 
pleasure.  The  dress  cut  princess  to  match  the  other  gar- 
ments is  preferable. 

"The  ordinary  baby  dresses  are  all  right,  except  that  I 
would  have  them  only  from  thirty  inches  to  a  yard  in  length. 

"Now,  these  three  garments  are  together  before  dressing- 
sleeve  within  sleeve— and  then  are  put  over  the  little  one's 
head  at  once  and  buttoned  behind,  and  the  baby  is  dressed, 
there  being  but  07ie  pin— a  diaper-pin— in  baby's  dress  in- 
stead of  fifteen. 

"At  night  the  dress  should  be  simply  a  Canton  flannel 
night-dress  and  a  diaper— the  dress  being  not  unlike  the 
undergarment  in  the  suit,  only  a  little  longer.  It  is  absurd 
to  think  that  a  child  can  rest  sweetly  in  a  diaper,  a  bandage, 
a  pinning  blanket,  a  shirt,  and  a  double-gown,  as  many  a 
child  is  expected  to  do. ' ' 

The  claims  made  for  this  method  of  dressing  were :  perfect 
freedom  to  all  thoracic,  abdominal,  and  pelvic  organs;  the 
clothing  hung  from  the  shoulders :  the  greatest  saving  of  the 
time  and  strength  of  the  mother  in  caring  for  the  babe ; 
resulting  health  and  comfort  to  the  child;  the  evenness  of 
the  covering  of  the  body,  there  being  the  same  covering  over 
the  shoulders  as  elsewhere. 

As  a  whole,  the  suit  was  very  satisfactory,  its  greatest 
merits  being  its  freedom  and  the  facility  with  which  it  could 
be  put  on,  giving  very  little  inconvenience  to  the  child.  Two 
general  objections,  however,  were  soon  made  to  the  suit. 
The  first  was  that  the  inner  garment  did  not  cling  closely 
enough  to  the  body  for  many  active  children,  there  being 
no  binder  to  protect  the  abdomen.  The  second  was  that  a 
better  material  than  Canton  flannel  could  be  found  for  the 


DRESS  AND   CLOTHING  53 

inner  garment,  since  the  downy  cotton  does  not  long  remain 
downy  unless  it  be  washed  by  very  skilful  hands.  Both  of 
these  objections  seem  well  founded,  and  in  an  ordinarily  cool 
climate  we  prefer  that  the  inner  slip  be  replaced  by  a  knitted 
shirt  with  sleeves,  long  enough  to  reach  the  diaper,  to  which 
it  may  be  pinned.  The  inner  slip,  therefore,  will  be  done 
away  with,  and  the  wool  flannel  middle  garment  comes  next 
to  the  shirt.  In  this  way  both  objections  are  met  by  one 
change. 

Various  other  materials  have  been  substituted.  The  best, 
aside  from  the  traditional  "baby-flannel,"  are  web-knitted 
stuffs,  which  are  very  elastic  and  pliable.  These  were  used 
in  various  suits  made  after  the  Gertrude  pattern.  These 
have  been  found  very  convenient  and  acceptable,  and  the 
inner  garment  may  be  easily  made  snug-fitting  without  being 
tight,  if  it  is  preferred  to  continue  the  original  Gertrude 
pattern  rather  than  to  change  to  a  shirt, 

NIGHT   DRESS 

Whatever  style  of  dress  is  adopted,  the  night  attire  con- 
sists, besides  the  diaper,  of  one  woolen  garment,  the  shirt 
or  its  equivalent  in  the  Gertrude  suit.  A  muslin  nightgown 
is  often  put  over  this,  but  if  the  inner  garment  of  woolen 
be  long,  no  other  is  needed. 

Various  devices  are  used  to  keep  the  feet  of  the  infant, 
after  it  becomes  active,  covered  by  the  nightgown.  The 
draw-string  is  convenient  for  the  mother  and  secure,  but  it 
is  rather  restrictive  of  the  motions  of  the  child's  feet.  But- 
tons and  buttonholes  across  the  entire  bottom  give  greater 
freedom.  Good  safety-pins  also  do  very  well.  If  the  night- 
gown be  kept  down,  no  stockings  are  needed  in  bed.  In 
fact,  if  the  bed-covers  are  warm  and  secure,  without  being 
tight,  no  particular  care  need  be  paid  to  the  lower  extremi- 
ties while  the  infant  is  in  bed.  The  bed-clothing  is  best 
secured  by  tapes  or  safety-pins,  extra  large  sizes  of  the  latter 
being  made  for  this  purpose. 


54 


THE  CENTURY  BOOK  FOR  MOTHERS 


SHOES 


So  long  as  long  clothes  are  worn  no  shoes  are  called  for; 
the  child  is  usually  better  without  them.  When  the  child 
begins  to  get  its  feet  out— when  it  is  short-coated,  in 
other  words — shoes  of  some  sort  are 
desirable,  especially  as  the  child  gets 
upon  the  floor.  The  procuring  of 
good  shoes— that  is  to  say,  properly 
shaped  ones— for  a  young  child  is  not 
easy.  The  ignorance  or  indifference 
of  manufacturers  regarding  the  shape 
of  an  infant's  foot  is  remarkable. 
Perhaps  it  is  less  so  now  than  a  few 
years  ago,  when  the  waiter,  looking  for 
shoes  of  the  shape  of  a  baby^s  foot, 
was  confidently  assured  by  the  shop- 
man that  ''there  is  no  shape  to  a 
baby 's  foot, ' '  probably  meaning  none 
that  he  could  not  distort.  The  ac- 
companying cut  is  an  imprint  from 
the  foot  of  a  new-born  infant.  The 
peculiarity  which  strikes  one  is  its 
breadth  and  the  inward  turning  of 
the  inner  side.  It  will  be  immedi- 
ately noticed  that  the  axis  of  the  foot 
is  not  drawn  down  the  middle  of  the 
foot,  but  from  the  center  of  the  heel 
through  the  center  of  the  ball  of  the 
great  toe  and  the  center  of  the  end  of 
that  toe.  This  is  not  arbitrary,  but 
the  line  is  that  upon  which  an  undistorted  foot  runs  in  its 
tire-like  movement  in  walking.  It  is  immediately  under  the 
strongest  part  of  the  arch  of  the  foot.  In  natural  walking 
these  axis  lines  of  the  two  feet  are  nearly  parallel.  If,  now, 
the  toe  be  turned  outward— that  is,  from  the  center  line  of 
the  body— ever  so  little,  the  axis  of  the  toe  is  no  longer  con- 


I 

The  dotted  line  shows 
the  inner  border  of  the 
foot,  which  doesnot  touch 
the  floor  in  standing. 


DRESS  AND  CLOTHING  55 

tinuous  with  that  of  the  foot,  and  the  motion  begins  to  lose  in 
smoothness  and  grace.  If  it  be  much  turned  out,  as  in  feet 
long  used  to  pointed  shoes,  the  gait  is,  to  the  trained  eye  at 
least,  little  better  than  a  limp,  and  is  almost  the  same  as 
after  the  loss  of  the  great  toe.  The  foot  is  distorted  easily 
in  proportion  to  the  youth  of  the  person,  and  misfitting 
shoes  in  infancy  and  childhood  usually  produce  deformities 
not  entirely  remediable  in  after  years  even  by  the  greatest 
care.  It  must  be  noted  also  that  stockings  are  nearly  or 
quite  as  destructive  of  shapeliness  of  the  feet  as  shoes,  and 
the  writer  has  watched  the  distortion  of  feet  of  adults,  care- 
fully looked  after  in  previous  years,  by  the  pointed-toed 
hosiery  sold  in  shops  of  late  years,  although  the  patient  had 
all  the  time  been  most  careful  as  to  the  shape  of  his  or  her 
shoes. 

FASHION    IN   DRESS 

As  the  child  grows  older  the  dress  changes  somewhat,  but 
for  several  years  the  change  is  not  very  radical.  After  nap- 
kins are  laid  aside,  drawers  take  their  place.  Young  chil- 
dren of  both  sexes  are  dressed  much  alike,  and  we  venture 
to  express  disapproval  of  the  tendency  of  fashion  in  recent 
years  to  put  little  boys  of  two  or  three  years  into  awkward 
breeches,  trousers,  or  even  stiff  leather  leggings  reaching 
nearly  to  the  hips,  the  child's  convenience  and  freedom  of 
motion  being  sacrificed  to  the  parents'  notion  of  ''style.'* 
If  it  be  desired  for  any  reason  to  discard  skirts,  the  knitted 
materials,  which  are  very  elastic,  or  garments  of  the  same, 
machine-knitted,  can  be  obtained  with  little  difficulty  in  most 
places. 

Fashion  and  convenience  of  purchasing  probably  will  al- 
ways govern  the  details  of  children's  clothing.  But  what- 
ever these  may  be,  the  principles  already  mentioned  should 
be  kept  in  mind— namely,  adequate  protection  without  bur- 
densomeness,  uniformity  of  protection,  absence  of  all  re- 
straint of  motion,  especially  such  as  is  caused  by  girdling  or 
binding.     These  should  be  kept  in  mind  not  only  in  child- 


56  THE  CENTURY  BOOK  FOR  MOTHERS 

hood,  but  through  adolescence.  To  no  one  is  this  freedom 
more  necessary  than  to  developing  girls;  neglect  of  it  may 
entail  mischief  of  long  duration.  Further,  it  must  be  added 
that  the  garments,  while  free,  must  be  of  comfortable  fit.  A 
garment,  for  instance,  which  is  badly  cut  in  the  neck  or 
slips  about  upon  the  shoulders  may  annoy  the  wearer  as  much 
as,  even  if  less  harmful  than,  too  tight  a  one,  and  these  dis- 
comforts may,  in  a  child  disposed  thereto,  excite  muscular 
twitchings  or  similar  disarrangements.  Similar  discomforts 
arise  from  unnecessary  multiplication  of  garments,  espe- 
cially if  numerous  bands,  belts,  or  folds  are  involved.  This 
objection  bars  out  many  contrivances,  seemingly  useful,  such 
as  diaper  supporters,  various  subdivisions  of  undergarments, 
etc.,  in  which  more  pins  are  required,  while  the  covering  is 
less  uniform. 


STOCKING   SUPPORTERS   AND    DRAWERS 

The  rule  which  forbids  girdling  or  confining  of  any  part 
will  exclude  the  use  of  tight  garters.  On  the  whole,  the 
stocking  supporter  which  connects  with  the  waist,  or  what- 
ever equivalent  garment  be  worn,  has  fewer  objections  than 
the  circular  garter,  and  it  is  therefore  to  be  preferred. 

The  night  apparel  of  infants  has  been  mentioned.  Until 
after  napkins  are  abandoned  it  requires  little  change.  Of 
the  various  methods  of  keeping  the  bottom  of  the  night- 
gown in  place,  buttoning  is  preferable  to  the  draw-string, 
unless  the  garment  be  so  long  that  the  narrowing  by  the 
drawing  up  does  not  extend  high  enough  to  confine  the  feet 
or  bring  them  in  contact  with  the  puckers.  For  a  child  two 
years  old  or  upward  the  one-piece  garment  known  as  *' night- 
drawers,"  with  or  without  feet,  is  generally  popular.  By 
it  the  child  is  completely  covered  by  one  thickness  in  any 
case,  however  restless  it  may  be.  Flannel  or  Canton  flannel 
is  the  commonly  used  material,  the  latter  probably  the 
more  used.  It  has  the  advantage  of  not  shrinking  much, 
but  in  other  respects  is  not  so  desirable  as  wool  flannels. 


DRESS  AND  CLOTHING  57 

The  seams  are  better  turned  outward,  as  they  are  rather 
clumsy  if  turned  inward. 


GARMENTS   FOR   OLDER  CHILDREN 

When  a  child  begins  to  creep  about  the  floor  some  gar- 
ment is  desirable,  not  only  to  protect  its  white  clothing  from 
dirt,  but  to  protect  it  in  some  degree  from  the  drafts  usually 
prevalent  there.  Of  such  there  are  several  patterns.  One 
is  not  unlike  a  loose  pair  of  the  "bloomers"  sometimes  used 
by  female  bicyclists,  fastening  about  the  waist  as  well  as 
below  the  knees.  Another,  affording  more  complete  protec- 
tion, is  like  a  child's  apron  having  sleeves,  but  with  the 
bottom  closed  except  for  leg-holes  or  with  short  trouser- 
like  extensions.  Thirdly,  little  suits  of  denim  overalls  are 
often  found  in  the  shops  where  children's  garments  are  sold. 

The  extra  protection  needed  or  desirable  when  the  child 
goes  out  of  doors  will  depend  upon  place  and  season.  In 
the  climate  of  the  northern  Middle  States  the  child,  while 
very  young,  should  in  cool  weather  be  taken  out  only  in  an 
attendant's  arms.  An  older  child  goes  out  in  its  baby-car- 
riage. Besides  its  winter  clothing  it  will  need  a  warm  cloak, 
a  warm  hood  or  close  cap  covering  the  ears,  a  veil  if  the 
weather  be  cold  or  windy,  and  warm,  loose  mittens  fastened 
by  safety-pins  or  buttons  to  the  sleeves,  not  tied  around  the 
wrists. 

Often  a  foot- warmer  of  some  description  is  needed,  and 
good  warm  carriage  wraps.  The  exact  weight  or  number 
of  these  cannot  be  given,  because  seasons  and  places  differ 
not  only  in  temperature,  but  in  dampness,  which  makes  a 
day  more  ''searching"  than  another  equally  cold.  A  feeble 
child  also  needs  special  protection.  The  guarding  against 
severe  winds,  the  avoidance  of  gusty  corners,  would  seem  to 
need  no  mention  did  we  not  daily  see  the  child's  comfort 
sacrificed  to  the  attendant's  social  instincts.  If  the  parent 
cannot  feel  safe  in  this  regard,  the  child  is  better  off  in  a 
well-aired  cold  room,  with  its  outdoor  clothes  on,  than  stand- 


58        THE  CENTURY  BOOK  FOR  MOTHERS 

ing  by  the  mouth  of  an  open  sewer  or  beside  a  foul  gutter. 
All  of  this  is  in  no  wise  intended  as  an  advocacy  of  undue 
coddling  or  burdening  of  the  child  with  needless  garments 
and  wraps.  It  is  merely  meant  to  suggest  that  the  child's 
airing  should  not  be  a  matter  of  bald  routine,  but  the  sub- 
ject of  a  careful  consideration  of  the  facts  and  conditions  in 
the  particular  case. 


VII 
GROWTH  AND  DEVELOPMENT 

GROWTH  and  development  present  many  aspects,  but 
are  the  same  essential  process.  To  the  casual  observer 
the  manifestation  of  most  importance  is  increase  in  weight, 
and  it  is  the  first  to  be  noticed.  All  growth  and  development, 
while  continuous,  is  not  strictly  uniform  in  rate,  and  many 
developmental  processes  may  almost  be  called  paroxysmal, 
because  the  periods  of  preparation  attract  little  attention, 
while  the  outward  manifestations  are  sudden. 

GAIN   IN  WEIGHT 

Let  us  begin  by  considering  the  increase  in  weight.  At  the 
very  first  the  child  loses  after  birth,  the  loss  corresponding 
with  those  days  during  which  there  is  no  milk  secreted  for 
its  use.  But  it  is  probable  that  the  loss  is  at  most  only  partly 
due  to  the  want  of  food,  since  it  has  occurred  in  children 
born  in  hospitals  and  from  the  first  put  to  breasts  in  which 
the  milk  was  established.  The  main  source  of  loss  is  doubt- 
less the  emptying  of  the  bowels  of  their  accumulated  secre- 
tions, as  well  as  the  passage  of  urine,  without  any  food-supply 
to  replace  their  weight.  Doubtless  tissue  changes  may  con- 
tribute somewhat.  Half  a  pound  or  more  is  lost  on  the 
average  during  the  first  few  days,  but  the  amount  is  made 
good  very  soon,  so  that  the  infant  by  ten,  or  at  least  four- 
teen, days  will  have  reached  a  weight  equal  to  that  at  birth. 
If  this  recuperation  has  not  begun  after  the  first  three  days 
the  milk-supply  would  better  be  inquired  into,  and  if  it  be 

59 


60  THE  CENTURY  BOOK  FOR  MOTHERS 

long  delayed  or  is  insufficient  there  is  reason  for  supple- 
mentary feeding  or  weaning. 

After  the  increase  begins  it  goes  forward— assuming  an 
adequate  and  suitable  supply  of  breast  milk— very  steadily 
and,  at  first,  rapidly.  A  net  gain  of  half  a  pound  a  week  is 
not  unusual  for  a  few  months,  and  at  least  a  quarter  of  a 
pound  is  to  be  expected.  Later  the  gain  is  less  rapid,  and 
if  it  be  charted  into  a  curve  the  latter  resembles  that 
of  a  body  thrown  into  the  air,  its  initial  rise  being  the 
most  rapid.  This  diminution  in  the  rate  of  gain  corre- 
sponds pretty  well  with  the  time  of  the  beginning  of  the 
process  of  teething,  and  it  may  be  that  a  part  of  the  develop- 
mental energy  is  diverted  into  that  channel. 

Since  the  rates  of  growth  are  calculated  from  a  mass  of 
infants  fed  upon  the  breast  it  may  be  proper  to  mention  at 
once  certain  ways  in  which  artificially  fed  children  may  be 
expected  to  vary  from  these  calculations.  To  begin  with,  a 
child  is  not  usually  put  upon  artificial  food  until  it  is  evi- 
dent that  its  natural  supply  has  failed.  In  the  meantime 
the  infant  has  fallen  behindhand,  and  has  something  to 
regain  beyond  the  normal.  Some  more  time  may  be  lost  in 
adjusting  its  food  to  its  needs  and  digestive  capabilities,  so 
that  altogether  the  little  one  makes  a  bad  start.  But  after 
the  food  is  properly  adjusted,  and  the  digestive  organs  have 
developed  in  ability,  the  gain  usually  overtakes  the  rate 
established  for  sucklings  after  some  months.  This  assumes, 
of  course,  a  well  adjusted  and  ample  nutriment.  We  find  that 
with  artificially  fed  infants,  as  seen  in  dispensary  practice,  for 
instance,  where  the  feeding  has  been  more  or  less  haphazard, 
developmental  processes,  such  as  teething,  are  retarded,  and 
that  these  children  get  their  teeth  on  an  average  some  time 
(perhaps  a  couple  of  months)  later  than  suckled  children. 

Assuming,  then,  a  child  upon  good  breast  milk  or  upon 
a  properly  arranged  food,  it  is  expected  that,  if  of  average 
weight  at  birth,  it  will  have  doubled  its  weight  by  the  time 
it  reaches  the  age  of  five  months,  and  have  trebled  its  weight 
by  the  end  of  its  first  year.     For  instance,  a  child  whose 


GROWTH  AND  DEVELOPMENT  61 

initial  weight  had  been  seven  pounds  might  be  expected  to 
reach  fourteen  pounds  in  five  months  and  twenty-one  in 
twelve  months,  gaining  about  as  much  in  the  first  five  montlis 
as  in  the  next  seven.  But  it  is  to  be  remembered  that  this  is 
an  average  and  applied  to  average  children.  It  may  be  that 
a  child  under  weight  at  birth  may  reach  the  average  by  five 
or  six  months,  and  very  likely  will  do  so  at  the  end  of  the 
year,  while  one  who  expects  a  ten-pound  baby  to  weigh 
twenty  and  thirty  pounds  at  these  periods  is  likely  to  be 
greatly  disappointed.  It  will  be  at  once  noted  that  the 
seven-pound  child,  who  reached  the  figures  first  given,  has 
made  an  average  weekly  gain  of  one  third  of  a  pound  in 
the  five  months,  and  of  a  scant  quarter  of  a  pound  in  the 
next  seven.  In  experience  the  ten-pound  baby  rarely  shows 
any  greater  capacity  for  gaining  than  the  average  baby.  So 
the  tendency  is  toward  the  average,  and  a  five-months'  child 
in  good  condition  usually  will  weigh  between  twelve  and  six- 
teen pounds,  and  a  yearling  eighteen  to  twenty-five,  about 
twenty  being  a  good  net  weight  if  a  large  number  of  children 
are  weighed. 

In  weighing  children  a  certain  time  of  day  should  be 
taken,  so  that  the  fullness  of  the  stomach  and  of  the  intes- 
tines shall  be,  as  nearly  as  practicable,  the  same. 

During  the  second  year  the  gain  is  about  six  pounds.  In 
the  subsequent  years  the  rate  of  gain  declines  somewhat,  as 
a  rule,  so  that  at  seven  years  the  weight,  even  with  ordinary 
indoor  clothing  (school  clothes),  is  less  than  fifty  (not  much, 
however,  and  in  some  places  not  at  all),  or  about  forty-five 
pounds  net.  Then  the  increase  is  rather  faster,  and  at  eleven 
girls  weigh,  clothed,  seventy  pounds,  and  boys  rather  more. 
Then  the  girls  gain  very  rapidly,  outstripping  the  boys,  and 
this  superiority  is  maintained  for  two  or  three  years  on  the 
average,  so  that  at  fourteen  both  are  close  to  one  hundred 
pounds,  the  girl  still  in  the  advance.  Thereafter  the  boy 
passes  the  girl,  and  at  sixteen  he  averages  from  one  hundred 
and  twenty  to  one  hundred  and  twenty-five  pounds,  and  she 
about  ten  pounds  less. 


62  THE  CENTURY  BOOK  FOR  MOTHERS 

GAIN   IN   HEIGHT 

CoiNCiDENTALLY  with  the  increase  in  weight  the  height,  or, 
as  it  is  usually  called  with  reference  to  an  infant,  the  length, 
is  increasing.  The  birth  length,  as  does  birth  weight,  seems 
to  vary  somewhat  according  to  races,  or  at  least  according 
to  countries,  and  even  in  different  parts  of  our  own  country 
differences  in  the  rate  of  growth  of  children  are  noted,  which 
may  be  due  more  to  racial  than  to  topographical  causes. 
But  American  statistics  give  the  average  length  of  new- 
born children,  both  sexes  included,  as  about  twenty  and  one 
half  inches.  The  gain  in  the  first  year  is  very  great,  being 
about  eight  inches.  In  the  second  year  it  is  usually  less 
than  half  that,  and  in  subsequent  years  still  less— three  or 
two  inches— until  the  great  impulse  to  growth,  about  the 
twelfth  year  in  girls  and  the  thirteenth  in  boys,  carries 
them  rapidly  toward  their  adult  stature.  Up  to  this  period 
the  average  weight  and  height  of  boys  is  a  little  more  than 
that  of  girls,  but  as  the  development  starts  earlier  with 
girls,  during  the  twelfth  and  thirteenth  years  the  latter  pass 
the  former  in  both  particulars,  and  their  greater  weight 
continues  even  through  the  fourteenth  year.  It  is  to  be  re- 
membered that  these  are  averages  of  averages,  because  in 
one  city  the  girl  is  found  to  be  the  taller  only  for  one  year, 
in  another  for  five  years,  her  superiority  in  this  respect 
beginning  earlier  and  continuing  later  than  in  other  places. 
These  variations  are  interesting  to  the  general  reader  only  as 
a  knowledge  of  them  may  prevent  undue  anxiety  in  case  the 
parent  finds  her  child  differing  much  from  any  table  of 
averages  she  may  happen  to  possess.  It  should  be  borne  in 
mind  that  family  peculiarities  have  great  influence  upon 
individual  cases,  especially  as  regards  height. 

Under  all  these  circumstances,  tables  for  popular  use  are 
of  doubtful  value,  since  those  not  in  the  habit  of  using  them 
are  apt  to  consider  that  they  have  an  authority  as  great  as 
tables  of  interest  or  of  logarithms.  We  may  say  in  brief 
that  the  average  height  of  a  child  of  two  years,  by  which 


GROWTH  AND  DEVELOPMENT 


63 


time  it  usually  begins  to  be  measured  standing,  is  about 
thirty-two  and  one  half  inches,  to  which  there  is  an  irregu- 
lar annual  addition  of  between  two  and  three  inches  until 
the  end  of  the  eleventh  year,  when  the  start  before  spoken 
of  begins  and  when  the  average  height  is  about  fifty-four 
inches.  By  fourteen  the  girl  has  reached  five  feet,  and  the 
boy  is  a  little  past  it.  After  that  time  the  girl  grows  slowly, 
and  the  boy  outstrips  her,  the  girl  at  sixteen  averaging  be- 


15  0  13  17  22 

Diagram  showing  proportionate  growth  of  different  parts  of  the  body  at  various  ages  from  i  to  *a 
years.  Dividing  the  height  at  one  year  into  four  equal  parts,  the  dotted  lines  show,  for  example, 
now  the  relative  size  oC  the  head  is  diminished  in  the  adult,  etc. 


tween  one  and  two  inches  beyond  the  five  feet,  while  the  boy 
is  probably  four  inches  taller  and  well  on  his  way  to  the 
completion  of  his  stature,  which  is  practically  attained  by  the 
time  he  reaches  his  majority,  although  it  is  a  fact  (as  shown 
by  the  careful  measurement  of  recruits  in  our  Civil  War) 
that  there  is  a  small  but  steady  increase  in  height  until  the 
age  of  thirty-five.  It  may  also  be  mentioned  that  no  ade- 
quate explanation  has  been  offered  for  the  enormous  growth 
which  has  been  observed  of  late  years  in  some  children,  espe- 
cially in  adolescent  girls. 

The  growth  of  the  body  is  accompanied  by  a  change  of 
proportions.  Every  one  is  familiar  with  the  relatively  large 
size  of  the  head  of  the  infant  as  compared  with  that  of  the 


64        THE  CENTURY  BOOK  FOR  MOTHERS 

adult.  So,  too,  the  great  proportionate  length  and  bulk  of 
the  trunk,  the  greater  size  of  the  abdomen  in  early  child- 
hood than  later.  The  preceding  cut  illustrates  fairly  ac- 
curately the  gradually  changing  proportions  of  the  entire 
body.  The  open  spaces  of  the  skull,  the  anterior  and  pos- 
terior fontanelles,  gradually  close  during  infancy;  the 
smaller,  posterior  one  being  completely  closed  so  early,  in 
about  two  months  after  birth,  that  mothers  and  nurses  seem 
rarely  to  recognize  its  existence.  The  larger,  the  anterior, 
one— the  "soft  spot"  of  ancient  nursery  lore — usually  re- 
quires about  a  year  and  a  half  for  its  complete  obliteration, 
although  this  may  occur  several  months  earlier  or  later. 

MUSCULAR   DEVELOPMENT 

In  early  infancy  the  actual  muscular  power  is  greater  than 
would  be  guessed,  on  account  of  the  want  of  coordination  of 
the  movements;  an  accidental  blow  from  the  baby's  hand 
or  foot  reveals  a  good  deal  of  force.  The  evidences  of  mus- 
cular coordination  and  control  come  very  gradually.  The 
first  movements  may  leave  us  in  doubt  as  to  their  inten- 
tional performance.  Thus  the  infant's  hand  may  very  early 
close  upon  the  mother's  finger  or  any  object  placed  upon 
its  palm,  while  considerable  time  will  elapse,  probably  as 
much  as  three  months,  before  the  child  grasps  anything 
with  unmistakable  intent.  It  will  likely  be  quite  as  long 
before  it  balances  its  head  of  itself  when  carried  in  arms. 
Later  still,  after  six  and  before  eight  months,  as  a  rule, 
the  child  gets  itself  into  a  sitting  posture  in  its  crib,  and 
is  able  to  maintain  it  longer  and  longer.  Soon  it  draws 
itself  up  beside  chairs  or  other  supports,  usually  between 
ten  and  twelve  months,  but  the  feat  of  walking  alone  is 
not  usually  accomplished  until  a  month  or  two  or  even  more 
of  the  second  year  have  passed.  But  in  walking,  more  than 
in  the  preliminary  feats,  probably  because  of  the  rather 
complicated  movements  of  balancing  required,  a  great  vari- 
ation in  time  exists.     We  have  noted  a  child  of  eleven  months 


'    GROWTH  AND  DEVELOPMENT  65 

who  walked  with  perfect  freedom,  and  many,  not  apparently 
ill,  who  were  equally  active  only  at  or  near  eighteen  months. 
It  should  be  especially  mentioned  that  any  intercurrent  ill- 
ness or  disturbing  condition  of  health,  sometimes  even  so 
slight  a  disarrangement  as  a  necessary  change  of  diet,  may 
impair  the  nice  adjustment  of  function  required  for  walk- 
ing, and,  in  popular  phrase,  ''put  the  child  off  its  feet." 
AYe  recall  many  such  instances ;  in  regard  to  one  the  mother 
remarked,  ''This  child  has  learned  to  walk  three  times." 


THE   SPECIAL   SENSES 

The  development  of  the  special  senses  is  quite  interesting. 
Probably  the  general  opinion  is  that  infants  are  born  with 
them  all  pretty  well  developed,  but  lack  means  of  showing 
this.  Actually  it  may  be  doubted  if  any  exist  at  birth.  The 
recognition  of  light  as  an  annoyance  seems  to  be  present  as 
soon  as  the  child  can  be  attended  to,  and  the  closed  eyelids 
exclude  it.  Little  by  little  it  becomes  used  to  the  light,  then 
seems  to  enjoy  it,  very  early  following  a  light,  if  not  too 
intense,  \^dth  its  eyes.  But  clear  vision  can  come  only  after 
the  muscles  of  the  eye  can  move  harmoniously,  and  months, 
perhaps  half  a  year,  must  elapse  before  the  child  has  sight 
in  the  sense  we  usually  mean  by  that  word. 

The  new-born  child  is  deaf,  but  its  hearing  comes  after 
certain  changes  in  the  ear  have  taken  place.  In  exceptional 
cases  hearing  has  been  definitely  noted  by  the  end  of  two 
months,  but  very  many  of  the  observations  on  this  point  are, 
in  the  writer's  opinion,  vitiated  by  the  confusion  of  hearing 
with  the  recognition  of  concussion.  Infants  are  notably  sen- 
sitive to  sudden  jars  even  without  sound,  and  many  of  the 
alleged  instances  of  hearing  seem  rather  to  be  cases  of  rude 
shaking. 

Touch  and  general  sensibility  are  both  far  less  marked 
at  birth  than  later.  This  is  especially  true  of  touch.  Taste, 
at  least  as  regards  some  substances,  seems  to  be  present  very 
early.     It  may  possibly  exist  at  birth.     It  is  not  easy  to 

5 


66  THE  CENTURY  BOOK  FOR  MOTHERS 

speak  certainly  about  smell,  owing  to  the  confusion  at  the 
earliest  age  between  manifestations  of  taste  and  of  smell. 
But  one  who  has  watched  the  action  of  a  young  infant  in 
being  put  to  the  breast  can  scarcely  doubt  that  the  sense  of 
smell  is  stimulating  its  incoordinate  struggle  to  reach  the 
nipple. 

SPEECH 

Two  other  signs  of  development  are  eagerly  watched  for— 
the  first  word  and  the  first  tooth.  Speech  is  remarkably 
variable  in  the  time  of  its  appearance.  There  can  be  little 
doubt  of  the  correctness  of  the  common  belief  that  girls 
speak  considerably  earlier  than  boys.  At  whatever  time 
speech  begins,  the  labial  sounds  and  the  broad  vowels  are 
pretty  certain  to  come  first,  and  the  infantile  pa-pa  and 
ma-ma  have  been  accepted  in  very  many  tongues  as  the  most 
endearing  of  titles.  The  child  generally  has  at  least  so 
much  of  language  within  its  first  year. 


THE   TEETH 

Dentition,  or  the  getting  of  the  teeth,  occupies  quite  a 
prominent  place  in  nursery  physiology  and  medicine.  For 
some  reason  the  eruption  of  the  second  set  seems  to  interest 
parents  far  less  than  the  first.  Probably  it  is  because  the 
first  teething  has  been  charged  with  more  causation  of  mis- 
chief—far more,  indeed,  than  it  is  probably  responsible  for. 
Before  birth  both  sets  already  exist  in  the  jaw  in  a  rudi- 
mentary condition,  and  those  of  the  temporary,  or  "milk," 
teeth  are  at  birth  well  advanced  toward  their  complete  con- 
dition. This  condition  is  as  follows:  The  bulk  of  the  tooth 
is  made  up  of  the  ivory,  or  dentine,  within  which  is  a  cavity 
having  the  same  general  shape  as  the  tooth.  This  is  called 
the  pulp  cavity,  and  contains  a  soft  substance  which  is  full 
of  blood-vessels  and  little  nerves,  which  may  become  very 
sensitive.  The  ivory  of  the  roots  or  fangs  of  the  tooth  are 
covered  by  a  bony  layer  called  the  cement.     The  part  of  the 


GROWTH  AND  DEVELOPMENT  67 

tooth  protruding  above  the  gum  is  called  the  crown,  and  is 
covered  with  a  layer  of  very  hard  substance  called  enamel, 
which  is  thick  on  the  tops  of  the  teeth,  and  gradually  be- 
comes thinner  as  the  gum  is  approached.  This  is  the  part 
of  the  tooth  we  usually  see,  practically  the  only  one  visible 
in  health.  The  whole  process  of  the  extrusion  of  the  tooth 
from  its  place  within  the  gum  to  its  place  without  is  called 
''teething." 

The  temporary  set  consists  of  twenty  teeth,  five  pairs  occur- 
ring in  each  jaw.  They  are  in  order,  counting  backward  from 
the    middle     of     the 

jaw,  the  central  inci-  !?!^.!^ 

SOrs,   the   lateral   inci-  Canine,      f  ^^-rr^2^\        Canine, 

sors,  the  canine  teeth, 
and  the  first  and  sec- 
ond molars.  The  in- 
cisors are  commonly 
called  ''front  teeth"; 
the  canine,  especially 

in  the  upper  jaw,  are  Temporary  Set. 

called  the ' '  eye  teeth, '  * 

probably  from  their  situation  beneath  the  eye,  and  those  of 
the  lower  jaw  are  often  called  the  "stomach  teeth,"  presum- 
ably from  a  supposed  greater  amount  of  disturbance  at  the 
time  of  their  appearance.  The  figure  shows  very  well  the  ap- 
pearance of  such  a  set  in  one  jaw.  The  order  of  the  appear- 
ance of  the  teeth  is  not  quite  the  same  in  the  two  jaws.  Thus, 
the  central  incisors  of  the  lower  jaw  appear  most  commonly 
in  the  seventh  month.  After  a  pause  of  a  month  or  two 
the  four  upper  incisors  follow.  After  another  pause,  perhaps 
a  little  longer,  come  the  lower  lateral  incisors  and  the  first 
molars.  A  more  decided  pause  then  comes,  and  somewhere 
between  the  age  of  a  year  and  a  half  and  two  years  come  the 
canines.  The  second  molars,  the  ''two-year-old  molars,"  as 
they  are  sometimes  called,  usually  come  in  the  first  half  of 
the  third  year.  So  that  on  the  average  a  yearling  child  will 
have  six  of  its  incisors.     At  eighteen  months  it  will  have 


68  THE  CENTURY  BOOK  FOR  MOTHERS 

added  the  other  incisors  and  the  first  molars,  making  twelve 
teeth.  The  next  six  months  add  the  canines,  making  six- 
teen in  all  at  two  years,  and  another  half  year  completes 
the  set  of  twenty  teeth.  But  it  should  be  clearly  understood 
that  in  perfectly  healthy  children  a  variation  as  regards 
this  time  may  exist  of  three  months  for  the  earlier  teeth 
and  of  six  months  for  the  molars.  Some  children  perfectly 
healthy  may  be  even  older  than  nine  months  before  a  tooth 
appears,  and  the  writer  has  several  times  seen  teeth  coming 
easily  through  at  four  months,  and  proportionately  early  for 
the  rest  of  the  set.  Unusual  delay  in  teething  will  always 
raise  an  inquiry  as  to  the  existence  of  the  condition  known  as 
rickets.  But  it  is  also  very  important  to  know  the  family 
peculiarity  in  this  regard,  as  with  perfect  health  it  causes 
remarkable  variations.  In  some  families  teeth  come  very 
early,  in  others  very  late.  Teeth  at  birth  are  occasionally 
met  ^\^th ;  cases  are  reported  in  which  the  peculiarity  has  been 
discovered  to  have  existed  for  several  generations.  The  pres- 
ent writer  has  noted  supernumerary  teeth  in  three  consecu- 
tive generations,  and  it  may  have  existed  still  farther  back. 
Observations  in  dispensary  practice  show  that  artificially  fed 
children  are  distinctly  behind  suckled  ones  in  time  of  teeth- 
ing. Whether  this  is  equally  true  of  carefully  and  wisely 
fed  children  we  have  as  yet  not  sufficient  data  to  determine. 
Certainly  much  depends  upon  the  time  when  the  artificial 
feeding  became  necessary,  children  who  get  a  good  start 
often  keeping  up  the  process  normally. 

There  is  a  rest  of  about  four  years,  when  the  eruption  of 
the  permanent  set  begins,  ' '  the  six-year-old  molars, ' '  as  they 
are  popularly  called,  being  the  first  to  appear.  The  name 
gives  sufficiently  closely  the  ordinary  time  of  their  eruption. 
They  come  next  to  the  second  temporary  molars,  and  seem 
to  make  a  decided  variation  in  the  order  of  the  appear- 
ance of  the  teeth.  But  the  remainder  of  the  permanent  teeth 
do  appear  in  a  sequence  very  similar  to  that  of  the  temporary 
ones.  Thus,  the  central  incisors  generally  come  at  about 
seven  years,  the  lateral  ones  following  quickly.     The  first 


GROWTH  AND  DEVELOPMENT 


69 


tricuspids  come  from  nine  to  ten  years,  the  second  bicuspids 
coming  about  a  year  later.  The  canines  then  come,  usually 
between  twelve  and  fourteen;  the  second  molars  follow 
pretty  quickly.  It  will  be  noted  that  the  precedence  of  the 
molars  over  the  canines  in  the  temporary  set  is  imitated  by 
the  forwardness  of  the  six-year-old  molars,  and  that  the 
place  occupied  in  the  temporary  set  by  the  molars  is  taken 
by  the  pointed  teeth  bearing  the  new  name  of  bicuspids, 
while  the  true  molars  come  behind  them  in  position.     The 


Incisors. 


Canine. 


Molars, 


\  Molars. 


Permanent  Set. 


last  molars,  four  in  all,  are  called  wisdom  teeth,  because 
their  eruption  is  delayed  until  an  age  usually  considered  the 
''age  of  discretion."  They  may  appear  at  any  time  from 
seventeen  to  twenty-five  years,  usually  about  twenty-one. 

A  word  should  be  added  regarding  the  care  of  the  teeth. 
From  their  first  appearance  they  should  be  kept  clean  by 
means  of  a  soft  cloth  and  water.  Their  durability  to  a  great 
degree  depends  upon  this.  It  is  a  mistake  to  suppose  that 
because  they  are  temporary  the  first  set  may  be  safely  ne- 
glected. It  is  important  that  they  be  kept  in  as  good  condi- 
tion as  possible  until  their  successors  appear,  and  in  case  of 
any  defect  or  decay  appearing  it  is  well  worth  while  to  give 
them  the  advantage  of  a  dentist's  care. 


70  THE  CENTURY  BOOK  FOR  MOTHERS 

Care  of  the  teeth  should  include  systematic  cleansing  of 
the  mouth  as  well. 

TEETHING 

The  foregoing  account  of  the  teeth  has  said  little  of  the 
process  of  their  eruption,  or  "teething."  The  usual  symp- 
toms are  these :  As  the  salivary  glands  are  developed  rather 
before  the  appearance  of  the  teeth  the  flow  of  saliva,  or 
' '  drooling, ' '  which  follows  is  usually  considered  as  an  indica- 
tion that  teeth  are  coming.  Possibly  the  irritation  of  the 
gums  may  excite  movements  of  the  mouth,  lips,  and  tongue 
which  exaggerate  the  flow  of  saliva,  but  in  the  main  the  two 
occurrences  are  simply  coincident.  When  the  eruption  is 
actively  in  process  the  gum  is  swollen  above  and  around  the 
coming  tooth.  It  may  be  hot  and  tender,  and  the  child  may 
be  thirsty,  fretful,  disturbed  in  sleep,  possibly  feverish,  and 
sometimes  remote  symptoms,  such  as  bowel  disturbances  or 
more  pronounced  nervous  symptoms,  may  appear.  With 
the  appearance  of  the  tooth  through  the  surface  of  the  gum 
the  local  symptoms  abate,  as  well  as  the  general  ones,  so  far 
as  they  have  depended  upon  the  irritation  of  teething. 

But  it  should  be  very  clearly  understood  that  disturb- 
ances have  been  attributed  to  the  process  of  teething  im- 
mensely beyond  the  truth,  owing  to  coincidences  being  mis- 
taken for  results.  No  one  familiar  with  children's  diseases 
at  all  doubts  that  very  much  disorder  of  health  and  discom- 
fort occur  at  the  time  of  teething.  Few  will  deny  that  some 
of  this  suffering  and  illness  is  caused  by  the  nervous  irrita- 
tion of  the  process.  Much  of  it  is,  however,  very  indirectly, 
if  at  all,  dependent  upon  the  teething.  Thus  the  immense 
majority  of  "teething  diarrhoeas"  are  due  to  improper  feed- 
ing, either  alone  or  through  its  overtaxing  a  digestion  al- 
ready disturbed  by  nervous  irritation.  Many  proofs  of  this 
could  be  adduced,  but  it  is  only  necessary  to  remind  the 
reader  that  those  teeth  which  are  cut  while  the  infant  is  at 
the  breast  cause  little  disturbance.  It  is  the  "eye  and  stom- 
ach teeth,"  teeth  which  come  in  the  middle  of  the  second 


GROWTH  AND  DEVELOPMENT  71 

year,  when  the  infant  is  not  only  weaned,  but  is  most  likely 
fed  with  many  improper  things,  which  cause  the  greatest 
trouble.  And  if  this  period  coincides  with  hot  weather, 
when  the  infant's  food  is  often  spoiled,  all  the  necessary 
circumstances  have  been  aggregated  to  give  the  "second 
summer"  its  popular  ill  repute. 

It  is  not  of  great  importance  to  decide  just  how  much 
disturbance  at  the  time  of  dentition  is  actually  due  to  the 
process  and  how  much  to  other  causes.  But  it  is  very  im- 
portant to  remember  that  teething  attended  with  other  than 
local  disturbance  is  pretty  certainly  not  normal  teething, 
and,  above  all,  that  stomach  and  bowel  troubles  are  not  to 
be  neglected  as  normal,  and  far  less  to  be  encouraged,  as  is 
not  infrequently  done,  as  a  beneficial  relief  to  the  system. 

The  local  symptoms  can  often  be  relieved  by  the  proper 
use  of  the  gum  lancet,  and  remoter  symptoms  should  be 
properly  treated. 

SATISFACTORY   GROWTH 

The  foregoing  remarks  upon  growth  and  development  will 
have  practically  answered  many  questions  often  asked  by 
mothers.  It  will  be  inferred  that  evidence  of  good  nutri- 
tion will  be  found  in  the  fact  that  a  child's  growth  and 
development  are  near  that  degree  described  as  the  average. 
Too  great  variations  either  in  fatness  or  leanness,  too  slow 
growth,  or  rapid  growth,  with  coincident  feebleness,  are 
reason  for  inquiry  into  the  adequacy  of  the  child's  dietary 
or  hygiene.  Such  inquiries  are  to  be  made  thoughtfully 
and  with  proper  frequency,  instead  of,  as  is  too  frequent, 
with  alternations  of  anxiety  and  neglect. 

The  thriving  child  is  generally  fairly  plump,  being  nei- 
ther skinny  nor  offensively  fat.  Its  skin  is  smooth  and  soft. 
It  sleeps  and  eats,  does  not  crj^  without  evident  reason,  per- 
forms its  functions  properly  and  regularly,  and,  if  it  has 
not  been  taught  bad  habits,  is  content  to  lie  quietly  in  its 
crib  when  it  has  been  fed  and  made  comfortable. 


72  THE  CENTURY  BOOK  FOR  MOTHERS 

As  the  child  advances,  its  occupations  and  requirements 
enlarge,  but  it  is  still  true  that  it  is  content  if  comfortable. 
It  adjusts  itself  to  its  surroundings  very  nicely.  The 
mother  who  attends  her  own  child,  suckling  it  if  she  can, 
bathing  it,  or  at  least  attending  at  its  bath,  will  soon  ac- 
quire a  knowledge  of  the  details  that  go  to  make  up  the 
"comfortable  baby,"  to  use  a  nursery  phrase.  Her  eye  will 
quickly  notice  a  departure  from  this  standard.  The  same 
sort  of  care  carried  through  childhood  will  give  prompt 
warning  of  anything  amiss. 

It  is  well  also  to  notice  whether  the  development  is  going 
on  in  a  symmetrical  manner,  or  at  least  as  symmetrically 
as  may  be  fairly  expected  from  the  child's  heredity.  An 
occasional  look  at  the  straightness  of  the  spine  or  the  square- 
ness of  the  shoulders  is  worth  while,  without  waiting,  for 
the  dressmaker  to  point  out  defects  in  these  regards.  Ex- 
amine the  feet  to  see  if  they  are  not  outgrowing  the  shoes, 
becoming  crumpled  in  a  pointed  shoe,  or  acquiring  corns, 
callus,  or  ingrowing  nails.  Proper  shoes  have  been  already 
described  (see  p.  54) .  Shoes  should  always  be  worn  which,  as 
far  as  practicable,  conform  to  the  natural  shape  of  the  foot. 
When  the  dictates  of  fashion  meddle  with  this  rule,  it  is 
well  to  remember  before  abandoning  it  that  there  is  more 
''style"  in  a  free  walk  than  a  fashionable  hobble.  In  cold 
weather,  especially  in  the  country,  watch  for  chilblains, 
which  are  more  easily  prevented  than  cured.  Also  notice 
if  there  is  a  tendency  to  cold  hands  or  feet,  which  is  usually 
considered  evidence  of  a  poor  circulation. 

When  the  child  begins  to  use  its  eyes,  notice  whether  it 
gets  nearer  to  or  farther  from  objects  which  it  is  examining 
than  do  other  children.  If  so,  it  may  be  near-sighted  or 
far-sighted.  Glasses  may  be  used  quite  early  in  life— that 
is,  as  soon  as  the  child  begins  to  study  or  do  any  near 
work— with  advantage  in  the  saving  of  the  capacity  of  the 
eyes.  Notice  also  if  it  have  enjoyment  or  discrimination 
of  colors.     If  there  be,  while  the  child  is  still  young,  rea- 


GROWTH  AND  DEVELOPMENT  73 

son  to  believe  that  it  is  in  any  considerable  degree  color- 
blind, it  should  have  especial  help  in  such  discrimination. 

Similarly,  notice  its  hearing,  and  especially  if  its  speech 
be  unusually  slow  in  developing.  And  even  if  the  latter 
be  normal  do  not  condemn  a  slow  child  as  stupid  or  inat- 
tentive until  it  is  certain  that  it  hears  well  and  that  there 
is  no  obstruction  of  the  nasal  passages  from  adenoid  growths 
or  otherwise.  In  addition,  it  is  proper  to  notice  whether  or 
not  a  child  breathes,  waking  or  sleeping,  through  its  mouth. 
If  so  its  nasal  passages  are  probably  obstructed. 

OUTGROWING   DEFECTS 

The  question  is  constantly  asked,  regarding  various  defects 
and  diseases,  "Will  the  child  outgrow  it?"  The  general 
answer  is  this:  If  the  defect  be  due  to  a  nutritional  or 
hygienic  error  which  can  be  recognized  and  corrected,  the 
defect  will  probably  be  improved  or  obliterated  by  such 
correction.  Otherwise  it  is  not  likely.  For  instance,  sup- 
pose a  rapidly  growing  child  shows  a  tendency  to  round 
shoulders.  Now,  if  it  be  found  that  this  is  due  to  near- 
sight  or  too  much  desk- work  or  too  low  a  desk,  and  proper 
glasses  be  provided  and  the  proper  changes  be  made  re- 
garding the  desk  and  amount  of  work,  the  defect  is  pretty 
certain  to  disappear.  But  if  precautions  be  neglected  the 
defect  will  persist,  and  probably  increase.  Similarly  of 
lateral  curvature  of  the  spine  at  its  beginning,  of  some 
curvature  of  the  legs,  or  of  distortions  of  the  feet  in  their 
earlier  stages.  So  also  club-foot,  recognized  and  treated 
early  is  quite  a  tractable  disorder;  if  neglected  till  late  it 
is  very  obstinate. 

But  of  diseases  in  the  ordinary  sense  of  the  word,  as  dis- 
tinct from  peculiarities  of  development,  it  is  fair  to  say 
that  they  are  rarely  outgrown.  They  run  their  course. 
Their  later  stages  may  differ  in  modes  of  manifestation  from 
the  earlier  ones.     The  untrained  observer  may  not  connect 


74        THE  CENTURY  BOOK  FOR  MOTHERS 

the  two.  But  the  physician  often  sees  in  an  adult  annoy- 
ance the  remnant  of  or  the  sequel  to  an  uncured  malady  of 
childhood. 

PHIMOSIS 

This  may  be  the  proper  place  to  speak  of  a  retarded  de- 
velopmental condition  called  phimosis.  At  birth  the  fore- 
skin of  male  infants  is  usually  somewhat  long  and  narrow. 
For  this  reason  and  because  of  adhesions  still  remaining 
between  the  foreskin  and  the  parts  it  covers,  the  foreskin 
cannot  usually  be  then  pulled  back.  But  it  is  not  many 
months  (certainly  within  two  years)  before  the  developmen- 
tal changes,  as  a  rule,  render  this  retraction  possible.  A 
certain  number  of  cases  do  not  undergo  this  change.  In 
them  the  condition  is  not  outgrown.  In  such,  or  whenever 
there  is  irritation  of  the  parts,  due  to  the  retention  within 
the  foreskin  of  matters  which  should  be  cleaned  out,  it  is 
well  to  relieve  the  condition  by  the  operation  of  circum- 
cision. It  is  an  operation  of  little  gravity,  and,  as  is  well 
known,  it  is  performed  as  a  ritual  ceremony  on  the  eighth 
day  by  those  of  the  Jewish  faith.  There  is  no  objection 
to  its  performance  under  ordinary  circumstances.  On  the 
other  hand,  it  is  by  no  means  universally  necessary,  as  some 
^'faddists"  pretend. 

CONDITIONS   OF   PROPER   DEVELOPMENT 

The  fact  that  a  satisfactorily  developing  child  is  usually 
comfortable  and  quiet  has  been  mentioned.  It  is  also  well  to 
remember  that  the  converse  is  equally  true— that,  namely,  a 
child  which  is  becoming  nervous  is  not  doing  well.  Not 
that  all  children  will  be  alike  in  temperament,  any  more 
than  will  their  parents.  But  if  a  child  has  by  heredity  a 
tendency  to  nervousness  it  ought  all  the  more  to  be  saved 
from  exciting  and  irritating  surroundings.  Good  hygiene, 
good  but  not  excessive  nutrition,  and  calm  environment  will 
give  the  best  chances  of  a  stable  nervous  system.     A  few 


GROWTH  AND  DEVELOPMENT  75 

details  may  be  given.  It  is  to  be  remembered  that  the  life 
of  a  new  baby  is  almost  a  vegetative  one.  Food  and  sleep 
and  the  little  waking  time  not  devoted  to  necessary  toilet 
the  child  devotes  to  acquiring  the  special  senses,  and  very 
gradually  learning  to  use  them.  The  amount  of  use  will 
in  effect  depend  upon  the  amount  of  nerve  force  it  has  to 
spare.  Obviously,  anything  which  may  be  done  to  increase 
the  child's  activity  in  this  respect  is  to  make  an  increased 
demand  upon  this  nerve  force.  So  for  the  first  few  months 
do  not  attempt  to  play  with  it.  It  is  not  a  toy.  For  those 
who  must  have  a  fixed  rule  it  may  be  said,  do  not  play 
with  a  baby  for  the  first  three  or  four  months.  But  the 
essential  thing  both  then  and  thereafter  is  to  follow  the 
child's  initiative.  The  soothing  sound  of  its  mother's  voice 
comforts  and  encourages  it.  So  do  the  gentle  touches  with 
which  it  is  laid  to  rest.  Every  one  knows  how  easily  it  is 
startled  by  sudden  or  loud  noises.  As  it  gains  the  use  of 
its  senses  and  looks  at  or  listens  to  things  about  it,  answer 
its  look  with  a  smile  or  its  listening  with  a  quiet  word. 
But  do  not  excite  it  with  play  for  the  sake  of  seeing  its 
response,  and  then  wonder  why  it  cries  when  you  cease. 
This  rule  of  sympathetic  appreciation  of  and  response  to 
the  child's  attempts  to  get  into  touch  with  its  surroundings 
without  over-stimulation  goes  all  through  the  developing 
age.  It  is  less  imperative  as  the  nervous  system  becomes 
more  stable,  but  it  continues  through  school  life  and  through 
the  growing  years. 

This  brings  up  the  question  of  overstudy  and  of  precocity 
and  dullness.  The  writer  believes  that  in  health  there  is 
practically  no  such  thing  as  overstudy.  The  mind  does 
what  it  can,  and  then  rests.  If  a  child  becomes  nervous 
under  study  or  seems  less  clever  than  usual,  the  intelligent 
thing  to  do  is,  not  to  assume  that  the  task  is  too  heavy, 
but  to  ascertain  if  the  child  is  well ;  if  it  sleeps  enough  and 
well  enough;  if  it  eats  enough,  slowly  enough,  regularly 
enough,  and  of  the  right  kind  of  food ;  if  its  physical  func- 
tions are  properly  performed;  if  its  eyes,  ears,  and  throat 


76  THE  CENTUEY  BOOK  FOR  MOTHERS 

are  normal ;  and,  lastly,  if  there  is  any  reason  why  the  child 
is  doing  its  work  under  worry  or  in  hurry.  The  child  may 
be  unable  to  do  its  arithmetic  examples  because  it  has  an 
indigestion,  or  is  cutting  a  molar,  or  what  not.  Exhaust  the 
physical  causes  before  attacking  the  school  curriculum. 

If  the  suggestions  about  calm  of  nervous  system  are  kept 
in  mind,  there  need  be  no  worry  about  precocity.  Much  is 
heard  about  the  need  of  keeping  books  away  from  preco- 
cious children.  Unwholesome  or  exciting  books  should 
surely  be  kept  away.  But  here  again  it  is  safe  to  trust  to 
the  child's  initiative.  Any  reading  or  study  of  wholesome 
books  which  it  does  of  its  own  accord  will  do  no  harm,  pro- 
vided it  gets  proper  outdoor  air  and  exercise.  But  the  child 
is  not  to  be  constantly  stimulated  by  the  conversation  and 
readings  of  its  parents  and  adult  friends.  This  is  the  ex- 
planation of  the  precocity,  often  unpleasant,  of  invalid 
children.  Debarred  from  the  sports  of  well  children,  they 
are  in  constant  contact  with  and  under  unceasing  stimulus 
from  adult  friends,  who  naturally  desire  to  make  up  to  the 
invalid  through  assiduous  attention  the  wholesome  enjoy- 
ments necessarily  lost. 

In  the  management  of  dull  or  somewhat  backward  chil- 
dren the  application  of  the  principles  takes  other  forms. 
It  has  been  shown  by  careful  scientific  and  vital  examina- 
tions of  large  numbers  of  school  children  ^  that  forwardness 
and  good  physical  development  are  found  together,  that 
poor  development  of  body  and  mental  backwardness  are 
associated.  If,  therefore,  a  child  be  backward,  its  physical 
condition  and  its  hygienic  surroundings  should  be  looked 
into,  and  any  errors  corrected  if  possible.  The  normal 
condition  being  restored  as  far  as  practicable,  it  is  proper  to 
inquire  then  whether  any  special  help  and  stimulation  are 
really  desirable. 

1  Quite  recently  Dr.  W.  S.  Christopher,  of  Chicago,  has  examined  the 
public  school  children  of  his  city  with  such  results. 


VIII 
FOOD   AND  FEEDING 

OF  course  the  basis  of  all  growth  and  development  is 
proper  nutrition,  and  this  depends  upon  proper  food 
and  feeding— that  is  to  say,  the  presenting  to  the  child  of 
such  aliment  and  in  such  form  as  its  digestive  apparatus  is 
capable  of  appropriating. 

BREAST   MILK 

Every  one  knows— although  it  sometimes  seems  to  require 
a  pitiable  amount  of  argument  to  convince  individuals  of 
the  truth— that  the  proper  and  ideal  food  of  a  new-born 
infant  is  breast  milk.  It  is  not  claimed  that  all  breast 
milk  is  just  the  same,  any  more  than  that  all  infants  are  the 
same  in  digestive  power  and  requirements.  Nevertheless, 
leaving  out  a  few  cases  of  diseased  or  imperfect  breast  milk, 
it  may  be  safely  asserted  that  there  is  such  an  adjustment 
between  the  digestion  of  an  infant  and  its  own  mother's 
milk  that  the  latter,  if  sufficient  in  amount,  does  agree  with 
the  child  and,  as  a  rule,  sufficiently  nourishes  it  even  in  cases 
where,  from  analysis  of  the  milk,  we  might  have  doubts 
that  it  would  do  so.  This  is  one  of  the  reasons  why  it  is 
not  always  practicable  to  substitute  one  breast  for  another. 
This  fundamental  fact  of  the  suitability  of  breast  milk 
as  an  infant's  food  is  more  completely  understood  when 
the  chemist  points  out  that  it  contains  in  a  wonderfully 
adjusted  form  all  the  ingredients  which  are  found  in  the 
necessary  food  not  only  of  infants,  but  of  all  human  beings, 

77 


78        THE  CENTURY  BOOK  FOR  MOTHERS 

not  to  mention  other  creatures.  These  ingredients  are  the 
proteids  or  nitrogenous  elements,  the  fats,  the  carbohy- 
drates, and  mineral  matters.  In  all  milks  the  proteids  are 
represented  by  the  part  which  forms  the  curd— that  is  to 
say,  the  casein  and  the  other  albuminoids  intimately  asso- 
ciated with  it;  the  fat  of  milk,  when  separated,  we  call  but- 
ter ;  the  carbohydrate  of  milk  is  milk-sugar,  and  in  solution 
are  a  number  of  salts,  chiefly  those  of  lime,  soda,  and  pot- 
ash necessary  for  the  economy. 

These  ingredients  are  found  in  varying  proportions  in 
the  milk  of  different  animals,  a  fact  which  must  be  kept 
clearly  in  mind  when  the  question  of  substitute  feeding 
comes  up.  For  us  the  standard  proportions  are,  of  course, 
those  of  breast  milk.  Taking  the  average  of  many  analyses 
by  various  chemists,  Ave  arrive  at  the  conclusion  that  the 
proteids  in  human  milk  are  between  one  and  one  half  and 
two  per  cent,  of  the  weight  of  the  whole;  fats,  about  four 
per  cent. ;  sugar,  about  seven  per  cent. ;  and  the  salts,  less 
than  one  fourth  of  one  per  cent.  But,  as  has  been  already 
said,  these  proportions  are  not  fixed.  The  percentage  of 
proteids  and  fat  are  very  variable,  from  two  to  six  per  cent., 
roughly  speaking,  while  that  of  sugar  is  much  more  nearly 
fixed.  The  great  bulk  of  the  milk— seven  eighths  by  weight 
—is  water,  and  in  it  the  nutrient  elements  are  dissolved  or 
suspended  in  a  state  of  fine  division,  so  that  they  are  pre- 
sented to  the  digestive  organs  in  a  form  which  they  may 
readily  attack.  Thus,  of  the  proteids  the  lactalbumen  is 
really  dissolved,  while  the  casein,  finely  divided,  is  held  in 
suspension,  probably  through  some  action  of  a  lime  phos- 
phate. The  fats  are  also  finely  divided,  and  held  in  the 
form  of  an  emulsion,  while  the  sugar  and  most  of  the  salts 
are  really  dissolved.  These  few  facts  are  given  because 
they  all  seem  to  have  bearing  upon  the  preparation  of  foods 
made  in  imitation  of  breast  milk. 

Each  of  these  ingredients  is  essential  to  a  proper  food. 
There  is  a  constant  waste  of  nitrogenous  matter  in  the  tissue 
changes  which  are  characteristic  of  life.     Only  by  proteids 


FOOD  AND  FEEDING  79 

can  this  waste  be  made  good.  But  if  one  were  to  try  to 
live  on  proteids  alone,  as,  for  instance,  upon  egg  albumen, 
the  heat  of  fat-producing  elements  would  very  soon  be 
missed,  as  heat  is  gained  from  proteids  only  by  a  relatively 
extravagant  consumption.  The  proteids  of  breast  milk  are 
very  digestible,  more  so  than  any  other,  to  the  human  diges- 
tion, and  herein  lies,  as  will  be  seen  later,  one  of  the  great- 
est difficulties  of  artificial  feeding  of  infants. 

The  fats,  on  the  other  hand,  are  heat  producers,  and  if 
combined  with  proteids  render  a  smaller  amount  of  the 
latter  necessary  to  nutrition.  There  are  also  a  number  of 
tissues,  bones,  and  nerves  especially,  to  the  nutrition  of 
which  fats  in  some  way  contribute.  The  animal  fats  are 
decidedly  more  digestible  than  are  vegetable  fats,  and  among 
the  former  the  fats  entering  into  butter  are  particularly 
digestible.  A  suckling  child  gets  in  its  breast  milk  an  amount 
of  butter  gradually  increasing  from  half  an  ounce  to  an 
ounce  and  a  half  daily,  speaking  approximately.  It  is  not 
strange,  therefore,  that  chemical  analysis  shows  that  quite 
a  considerable  proportion  of  this  passes  away  in  the  evacua- 
tions. In  so  doing  it  acts  as  a  laxative,  and  is  not  there- 
fore useless. 

The  carbohydrates  are  also  heat  producers,  and  they  are 
in  part  changed  into  fats  and  as  such,  together  with  a  part 
of  the  fats  taken  into  the  system,  are  stored  up  in  the  tis- 
sues, especially  in  the  considerable  fatty  deposits  so  charac- 
teristic of  well-nourished  infancy.  The  carbohydrate  of 
milk  is  milk-sugar,  its  name  showing  that  it  is  peculiar  to 
this  liquid.  Yet,  other  sugars  of  the  same  group,  for  in- 
stance, cane-sugar  or  malt-sugar,  can  be  substituted  success- 
fully for  the  milk-sugar,  with  little,  if  any,  of  the  incon- 
venience which  attends  the  substitution  of  other  proteids 
or  fats  for  those  of  milk.  It  is,  however,  not  safe  to  carry 
the  substitution  of  carbohydrates  very  far.  Thus,  while  it 
is  perfectly  true  that  the  adult  digestive  organs  have  the 
power  of  changing  a  large  amount  of  starch  into  sugar,  this 
is  not  true  for  the  infant^  in  whom  the  power  exists  only  in 


80  THE  CENTURY  BOOK  FOR  MOTHERS 

a  slight  degree.  Hence  the  digestive  disorders  so  often  seen 
in  infants  when  the  latter  are  obliged  to  take  a  food  con- 
taining starchy  matter  in  any  considerable  amount.  The 
small  amount  of  salts  in  milk  are  of  direct  use  in  some  in- 
stances, as  the  lime  salts  needed  for  the  bones,  and  also 
probably  quite  as  much  so,  although  not  so  evidently,  in  facil- 
itating various  nutritional  processes,  to  the  proper  perform- 
ance of  which  the  presence  of  these  salts  seems  to  be 
essential. 

If  we  assume  that  a  good,  suitable  breast  milk  is  the  best 
food  for  an  infant,  it  hardly  need  be  said  that  a  substitute 
food  should  approximate  as  nearly  as  possible  the  constitu- 
tion of  breast  milk.  How  shall  this  be  accomplished?  The 
oldest  substitutes  of  which  we  have  knowledge  were  the  milks 
of  the  domestic  animals,  whole,  diluted,  or  modified  in  some 
way.  To-day  scientific  attempts  to  provide  accurate  sub- 
stitutes have  brought  us  back  to  the  same  basis. 

ARTIFICIAL   FEEDING 

But  what  of  the  multitudes  of  proprietary  infant  foods? 
Little  need  be  said.  It  would  be  useless  to  go  into  any 
prolonged  consideration  of  such  foods  as  cannot  be  recom- 
mended.    The  foods  in  common  use  are  of  several  types. 

First,  because  probably  the  longest  in  use,  are  the  cereal 
foods,  used  with  water  or  with  milk.  Such  are  the  arrow-root, 
various  flour  and  meal  mixtures,  more  recently  the  barley 
and  oatmeal  preparations,  and  many  others.  Of  course,  these 
and  the  following,  if  milk  enters  into  the  preparation  of  the 
food,  cease  to  be  cereal  preparations,  but  are  of  mixed  types. 

Second,  the  malted  foods  which  originated  with  the  chem- 
ist Liebig,  and  by  his  name  they  are  often  called. 

Third,  the  milk  foods.  Condensed  milks  ought  here  to 
be  included,  because,  although  not  called  infant  foods,  they 
are  largely  used  as  such.  They  are  essentially  condensed 
and  dried  milk,  with  the  fat  removed  to  a  great  degree  to 
permit  of  the  drying. 

Beside  these  groups  are  many  foods  not  easy  to  classify, 


FOOD  AND  FEEDING  81 

many  of  them  being  compounds  in  which  one  or  more  of 
the  foregoing  type  ingredients  are  mingled. 

Now,  the  first  group  has  the  serious  objection  that  the 
foods  contain  a  large  amount  of  unconverted  starch— that  is 
to  say,  starch  which  must  enter  the  digestive  organs  as 
starch,  which,  as  has  just  been  said,  the  young  infant's 
digestion  cannot  properly  deal  with. 

The  group  of  Liebig's,  or  malt,  foods  usually  contain  an 
enormous  amount  of  sugars,  some  of  it  being  cane-sugar,  but 
the  great  bulk  either  malt-sugar  or  grape-sugar  or  both, 
neither  of  which  is  harmful  in  proper  amount,  but  which, 
as  they  are  found  in  the  foods,  tend  to  give  the  infant  excess 
of  fat;  and  since  the  foods  are  deficient  in  fats  and  the 
proteids  are  not  always  of  animal  origin  the  strength  and 
nutrition  of  the  child  are  really  below  normal,  while  its  bulk 
is  quite  imposing.  As  a  result,  the  show  baby  is  often 
rather  an  alarming  object  to  the  physician  familiar  with 
infants  in  health  and  sickness.  The  milk  foods  usually,  if 
not  always,  have  the  defect  that  the  fat  was  in  part  removed 
from  the  milk  in  order  that  the  food  could  be  made  or  pre- 
served. In  so  far,  if  for  no  other  reason,  they  fail  to  rep- 
resent milk  as  a  basis  for  infant  food. 

It  is  not  charged  that  these  foods  are  distinctly  unwhole- 
some, or  that  they  will  not  sustain  life.  A  number  of  them 
are  intended  to  be  prepared  with  milk,  and  owe  most  of 
their  value  to  this  addition,  which  would  usually  be  itself 
a  better  basis.  Further,  some  of  them,  in  later  infancy  or 
for  older  children,  may  without  impropriety  become  a  part 
of  a  dietary  already  amplified.  But  the  writer  has  for 
many  years  never  felt  safe  to  keep  a  child  long  upon  any 
one  of  them.  For  short  periods,  especially  when  an  overfed 
digestive  system  needed  rest,  they  have  been  found  useful. 

COW'S   MILK 

What,  then,  is  to  be  the  basis  of  a  proper  infant's  food? 
Practically,  we  are  driven  to  the  milk  of  some  domestic  ani- 
mal.    In  civilized  countries  that  of  the  goat,  the  ass,  and 

6 


82        THE  CENTURY  BOOK  FOR  MOTHERS 

the  cow  is  the  only  available  one,  and  the  last  named 
is  the  only  one  in  this  and  most  countries  which  can  be 
obtained  in  sufficient  quantity  and  with  sufficient  certainty 
to  make  it  worth  considering.  But  it  must  be  kept  in  mind 
that  cow's  milk  is  not  the  best  food  for  young  infants,  but 
that  it  is  the  best  basis  for  such  a  food.  Many  things  have  to 
be  attended  to  to  obtain  this  desirable  food,  and  these  relate 
to  two  general  objects— the  procuring  of  pure  cow's  milk 
and  the  modifying  of  that  milk  in  such  ways  as  will  adapt 
it  both  to  the  nutrition  of  the  infant  as  well  as  to  its  diges- 
tive powers. 

What  is  pure  milk?  The  ordinary  answer  is  milk  just  as 
it  comes  from  the  cow,  to  which  no  water  and  no  adultera- 
tions have  been  added.  But  this  does  not  meet  a  physician's 
idea  of  pure  milk,  which  is  of  late  expressed  by  the  term 
clea7i  milk. 

PURITY  OF   THE   MILK   SUPPLY 

The  cow  is  not  a  tidy  animal,  even  with  the  freedom  of  a 
pasture.  Under  the  conditions  in  which  she  is  usually  kept 
in  the  winter  she  is  dirty  enough.  Any  one  familiar  with 
her  appearance  in  or  about  the  ordinary  country  barn  pre- 
fers to  forget  it.  Ordinarily  the  milker  is  hardly  an  im- 
provement in  this  respect.  And  the  froth  of  the  ''foam- 
ing pail ' '  is  usually  well  decorated  with  unmentionable  filth 
before  the  milk  is  strained.  These  points  need  not  be  dwelt 
upon,  for  the  present  object  is  not  to  prevent  the  use  of 
milk,  but  to  stimulate  the  use  of  good,  clean  milk.  For 
quite  a  number  of  years  growing  attention  has  been  given 
by  physicians  and  others  who  were  enthusiastic  in  the  matter 
to  the  production  of  milk  for  the  market  which  should  be 
really  pure.  As  knowledge,  scientific  and  practical,  has  in- 
creased, improvements  in  method  have  become  possible, 
until  now  milk  of  remarkable  purity,  as  well  as  of  uniform 
high  quality,  is  obtainable  in  many  of  the  large  cities. 
Milk  nearly  as  good  ought  to  be  procurable  in  country  places 
and  small  towns  if  consumers  are  made  aware  of  the  neees- 


FOOD  AND  FEEDING  83 

sary  requirements  for  its  production  and  insist  upon  them. 
Probably  the  best  way  to  put  forward  those  requirements 
^^dll  be  to  describe  briefly  and  without  unnecessary  detail 
what  actually  is  done  in  some  of  the  best  clean  milk-farms 
in  the  vicinity  of  New  York. 

First,  the  farm  itself  is  chosen  for  the  excellence  of  its 
pasturage  and  water-supply,  the  wholesomeness  of  its  soil, 
and  the  drainage  of  the  same.  The  barns  are  so  constructed 
that  there  shall  be  ample  room,  air-space,  sunshine,  and 
ventilation,  without  exposure,  for  every  cow.  The  floors  are 
made  of  some  substance  which  can  be  kept  clean  and  free 
from  the  soaking  in  of  filth,  cement-like  materials  perhaps 
having  the  most  advantages.  Devices  for  watering  and 
feeding  in  the  cleanliest  manner  are  employed,  and  others 
for  the  complete,  rapid,  and  frequent  removal  to  a  distance 
of  all  filth.  The  air  of  the  stable  is  always  free  from  foul 
odors.  The  feed  is  arranged  upon  the  most  approved  sched- 
ules, based  upon  experience  and  scientific  experimentation, 
and  kept  in  other  barns  away  from  the  stables. 

Before  a  cow  can  be  admitted  to  these  barns  she  must 
have  passed  the  quarantine— that  is  to  say,  every  cow  bought 
is  brought  to  a  quarantine  barn,  not  only  to  await  the  devel- 
opment of  any  acute  disease  she  may  have  become  affected 
with,  but  in  most  of  these  farms  to  be  subjected  to  the  tuber- 
culin test.  Unless  this  shows  her  to  be  free  from  tuberculosis 
she  is  rejected.  If  she  proves  to  be  sound  she  takes  her  place 
in  the  milking-herd. 

Thus  far  the  provisions  insure  a  sound  cow  brought  into 
the  best  hygienic  surroundings,  fed  and  attended  in  the  best 
known  manner.  Such  a  cow  should  furnish  sound  milk. 
The  next  problem  is  how  to  keep  the  milk  uncontaminated 
on  its  way  from  the  udder  to  the  consumer.  The  ordinary 
sources  of  contamination  are  from  the  cow's  body,  from  the 
milker,  from  unclean  vessels  or  containers  at  every  step. 
The  cow,  by  reason  of  the  great  tidiness  of  these  stables,  is 
free  from  obvious  filth.  In  addition,  each  cow  is  daily 
groomed,  like  well-kept  horses.     Still  further,  just  before 


84  THE  CENTURY  BOOK  FOR  MOTHERS 

the  milking  the  abdomen  and  adjacent  parts  of  the  cow  are 
brushed,  to  remove  any  loose  hairs  which  might  fall  into  the 
milk,  and  the  udders  are  cleansed  by  a  man  who  precedes 
the  milker. 

The  men  who  are  employed  about  the  stables  are  carefully 
and  frequently  examined  as  to  their  own  health,  no  one 
suffering  from  chronic  or  acute  ailments  being  allowed  about 
the  cattle.  Owing  to  the  danger  of  the  conveyance  by  milk 
of  some  contagious  disorders,  notably  scarlatina,  which  usu- 
ally prevails  among  children,  some  model  dairies  have  ex- 
cluded all  married  men  from  their  service  for  fear  that  they 
should  bring  contagion  from  home  to  the  milk.  The  milker, 
before  beginning  his  work,  puts  on  a  clean  white  suit  of 
overalls  and  a  white  cap,  carefully  cleans  his  hands  and  his 
nails.  This  washing  is  usually  repeated  after  the  milking 
of  two  cows,  in  some  dairies  after  each  cow.  But  the  dry 
hand  only  is  used  in  milking. 

All  vessels,  from  milking-pail  to  bottles,  are  carefully 
sterilized  with  steam,  often  under  pressure,  before  using. 
Each  milking-pail  is  protected  by  a  well-fitting  cover,  in  the 
center  of  which  is  a  circular  piece  of  wire  gauze  surrounded 
by  a  high  lip  of  the  same  metal  as  the  cover,  so  that  the 
milk  is  drawn  into  a  sieve  pan  through  which  it  must  run 
to  enter  the  pail.  It  is  customary  not  to  permit  the  very 
first  milk  to  enter  the  pail,  as  it  is  known  that  the  udders 
themselves  usually  contain  bacteria  in  considerable  number. 
Hence  the  first  spurts  are  thrown  away.  The  milking-pails 
are  emptied  into  sterilized  cans,  and  the  latter  quickly  trans- 
ferred to  the  milk-room  at  a  distance  from  the  stable.  Here 
everything  is  kept  in  a  state  of  complete  cleanliness,  the 
utensils,  apparatus,  and  the  room  itself  being  cleansed 
with  steam.  The  milk  is  strained  through  absorbent  cotton, 
and  is  rapidly  cooled  by  cooling  apparatus,  so  that  in  a  very 
short  time,  not  more  than  twenty  minutes  from  the  udder, 
the  milk  is  cooled  to  the  desired  temperature,  which  in  the 
best  dairies  is  40°  F.  Of  course,  the  same  scrupulous,  sci- 
entific  cleanliness  is   carried   out  in  the  bottling  and  the 


FOOD  AND  FEEDING  85 

keeping  of  the  milk  until  placed  in  the  hands  of  the  con- 
sumer. 

The  effect  of  these  "model"  dairies  has  been  far-reaching. 
Within  a  very  few  years  the  writer  has  heard  the  proposal 
to  exercise  such  care  as  has  been  described  not  only  charac- 
terized as  Utopian,  but  greeted  with  laughter.  Now,  not 
only  do  such  farms  exist  in  the  vicinity  of  many  great  cities, 
but  many  other  farms  are  conducted  in  a  way  which  shows 
the  influence  of  their  example.  It  is  now  easy  to  get  milk 
of  a  degree  of  cleanliness  which  a  few  years  ago  was,  at 
least  in  most  places,  unobtainable. 

The  purpose  of  all  these  precautions  is  of  course  to  ob- 
tain a  milk  free  from  all  disease  germs,  and  also  with  as 
few  bacteria  as  possible.  The  various  undesirable  changes 
of  milk— its  ''spoiling,"  "souring,"  or  "turning,"  in  com- 
mon parlance— are  due  to  the  activity  of  some  of  the  kinds 
of  these  organisms.  It  is  not  expected  that  milk  will  be 
obtained  entirely  free  from  bacteria.  It  is  doubtful  if  such 
can  be  had,  or  if  the  human  milk  drawn  from  the  mother's 
breast  is  ever  absolutely  sterile.  In  most  cases  we  know  that 
it  is  not.  AVe  also  know,  however,  that  milk  containing  few 
bacteria  keeps  very  Avell,  and  may  in  case  of  need  be  kept, 
if  cold,  without  cooking  or  sterilization,  many  days  without 
any  harmful  change. 

But  it  is  a  part  of  the  regime  of  a  clean  milk-farm  to 
furnish  its  product  only  very  fresh.  The  milk  ordinarily 
sold  in  great  cities  in  the  morning  is  a  mixture  of  milk 
of  the  previous  morning  and  of  the  night  before— that  is 
to  say,  it  comes  to  the  consumer  twenty-four  or  thirty-six 
hours  old.  Under  the  circumstances,  it  is  wonderfully  good. 
But  it  has  always  been  the  aim  of  the  producers  of  clean  milk 
to  deliver  it  within  a  few  hours  after  it  is  drawn,  and  it  is 
sold  not  more  than  twelve  hours  old,  often  less.  So  much 
of  the  details  of  a  "clean"  dairy  has  been  given  in  order 
that  those  who  will  read  this  may  have  some  standard  by 
which  to  judge  of  the  state  of  the  source  of  their  own  milk- 
supply  and  the  probable  condition  of  the  milk  itself.     It 


86  THE  CENTURY  BOOK  FOR  MOTHERS 

is  true  that  when  milk  is  not  what  we  wish  it  to  be,  we 
have  in  Pasteurization  and  sterilization  invaluable  re- 
sources, but  the  object  aimed  at  is  a  milk-supply  sufficiently 
pure  to  render  these  aids  unnecessary. 

A  pure  milk-supply  being  assured,  what  shall  he  the  in- 
fants foodf 

THE   CONSTITUENTS   OF   MILK 

It  cannot  be  pure  cow's  milk.  This  is  so  generally  the 
experience  of  observers  not  only  now",  but  during  genera- 
tions, that  we  need  not  stop  to  consider  the  exceptional  in- 
stances of  infants,  usually  not  the  youngest,  who  have  been 
able  to  digest  whole  milk  and  to  thrive  more  or  less  well. 
The  objection  to  the  use  of  whole  milk  for  young  children 
is  not  the  result  of  scientific  theory,  nor  is  it  based  merely 
upon  the  experience  gained  from  using  milk  not  perfectly 
fresh,  as  in  cities,  but  it  was  recognized  equally  well  long 
ago  in  country  districts  when  the  milk  could  be  had  di- 
rectly from  the  cow.  Nevertheless  scientific  inquiry  makes 
evident  the  reason  of  the  difficulties  universally  experienced. 
The  constituents  of  human  milk  have  already  been  given 
as,  on  an  average,  approximately: 

Fat     ....  4    per  cent.    Salts    .    .  i  to  i  per  cent. 
Sugar    ...  7         "  Water.    .    .  87-f     " 

Proteids   .    .  li       " 

This,  of  course,  sets  aside  for  the  moment  the  variations  in 
different  specimens.  Examined  in  the  same  way,  good  cow 's 
milk  from  a  mixed  dairy  herd  averages  about  as  follows : 

Fat 4  per  cent.     Salts     ...    J  per  cent. 

Sugar  .    .   .    .  4i     "  Water  ...  87       " 

Proteids     .    .  4       " 

If  there  be  in  the  herd  a  large  proportion  of  Jersey  cows, 
the  percentage  of  fat  will  be  appreciably  higher;  if  of  Hoi- 


FOOD  AND  FEEDING  87 

stein  cows,  it  will  be  lower.  Sugar  and  proteids  vary  little ; 
fat  varies  greatly  in  different  specimens  of  milk,  a  fact 
perfectly  well  recognized  in  the  phrases  ''rich  milk," 
"creamy  milk,"  "blue  milk,"  in  popular  use. 

Now,  it  will  be  at  once  noticed  that  the  amount  of  water  is 
about  the  same  in  human  milk  and  in  cow's  milk,  that  the 
salts  are  much  more  abundant  in  cowl's  milk,  and  that  of 
the  three  ingredients,  fat,  sugar,  and  proteids,  the  total  is 
very  nearly  the  same,  the  human  milk  often  comparing  more 
favorably  than  as  given  in  the  above  tables.  But  it  will 
also  be  noticed  that  this  amount  is  divided  very  differently 
in  the  two  milks.  The  amount  of  fat  differs  little.  Of 
sugar  human  milk  contains  much  more,  nearly  twice  as  much, 
while  the  cow's  milk  equalizes  this  deficiency  in  solids  by 
an  increased  amount  of  proteids,  which  is  pretty  uniformly 
near  the  average  of  fully  four  per  cent.,  while  in  human 
milk  the  amount  is  very  variable.  We  have  averaged  it  at 
one  and  one  half  per  cent.— not  much  more  than  one  third 
the  amount  found  in  cow's  milk. 

There  is  still  further  a  difference  not  evident  in  the  tables, 
which  is,  however,  quite  important— namely,  that  the  pro- 
teids in  the  two  kinds  of  milk  differ  not  onl}^  in  quantity, 
but  in  kind.  It  has  already  been  mentioned  that  the  pro- 
teids in  breast  milk  are  very  digestible.  This  is  not  equally 
true  of  the  proteids  of  cow's  milk  for  the  infant's  digestion. 
Both  kinds  of  milk  have  at  least  two  kinds  of  proteids,  one, 
called  casein,  is  coagulable,  the  other,  called  lactalbumen,  is 
soluble  and,  while  coagulable  by  heat,  makes  a  very  much 
less  tough  curd  than  does  casein.  In  cow's  milk  the  casein 
makes  the  great  bulk  of  the  proteids,  while  in  human  milk 
the  lactalbumen  is  tAvice  as  abundant  as  the  casein.  Every 
one  familiar  with  infants  will  at  once  recall  the  soft,  light 
curd  of  regurgitated  breast  milk,  and  the  heavy,  often  hard, 
curd  of  vomited  cow's  milk. 

Inasmuch  as,  so  far  as  is  known,  the  milk-sugar  in  both 
kinds  of  milk  is  of  the  same  kind,  and  the  fats  essentially 
the  same,  it  will  be  seen  that  the  difficulty  in  adjusting  cow's 


88  THE  CENTURY  BOOK  FOR  MOTHERS 

milk  to  the  needs  of  a  j^oung  infant  must  lie  chiefly  in  the 
management  of  the  proteid  ingredient. 

If  the  relative  proportions  of  the  three  nutritive  ingre- 
dients, fat,  sugar,  and  proteids,  in  the  two  kinds  of  milk  be 
kept  in  mind  it  will  at  once  be  seen  that  by  simple  dilution 
of  cow's  milk  with  two  parts  of  water  the  proteid  percentage 
of  the  mixture  would  be  not  far  from  that  of  human  milk. 
But  the  fat  percentage,  which  should  be  unchanged,  will  be 
likewise  diluted,  as  will  that  of  sugar,  which  was  far  too 
loAv  before  dilution.  Sugar  of  milk  or  another  sugar  can  be 
added  in  the  necessary  quantity,  but  whence  shall  the  fat 
value  be  obtained?  This  last  problem  is  the  stumbling- 
block  of  the  commercial  foods,  owing  to  the  difficulty  of 
preserving  the  fats. 

MODIFIED   MILK 

Long  ago  the  value  of  cream,  or  rather  "top-milk,^'  as  a 
basis  of  food  for  infants  was  recognized,  as  it  gave  a  larger 
percentage  of  fat  than  did  the  whole  milk.  To  such  or  a 
similar  basis  has  the  scientific  search  for  a  food  brought  us 
back— to  a  basis,  namely,  which  offers  us  fat  and  proteids 
in  such  proportions  than  on  dilution  the  relative  percentages 
which  we  desire  may  be  obtained.  The  great  improve- 
ments in  infant  feeding  of  recent  years  in  America  consist 
not  in  providing  a  new  kind  of  food,  but  in  applying  meth- 
ods of  precision  to  a  kind  of  food  shown  by  long  experience, 
as  well  as  by  chemical  inquiry,  to  be  peculiarly  adaptable  to 
the  needs  of  infancy.  With  the  improvements  of  dairy 
appliances  it  is  possible  to  separate  the  cream  from  the 
milk  not  only  quickly,  but  in  almost  any  desired  degree  of 
fat  value.  The  fat  value  can  also  be  accurately  deter- 
mined. With  these  facilities,  the  next  step  was  a  natural 
one — namely,  to  recombine  the  elements  of  the  milk  in  such 
proportions  as  shall  approximate  those  of  human  milk, 
or  to  make  any  other  similar  combination  which  may  be 
desired. 

The  credit  of  the  practical  working  out  of  the  details  of 


FOOD  AND  FEEDING  89 

this  problem  belongs  primarily  to  Dr.  Rotch,  of  Boston,  and 
Mr.  G.  E.  Gordon.  Their  work  has  been  seconded  by  that  of 
pediatrists  all  over  the  country,  and  during  ten  years  not  only 
have  great  improvements  in  method  been  made,  but  a  very 
helpful  accumulation  of  exact  experience  has  been  formed, 
so  that  to-day  the  matter  of  infant  feeding  is  upon  a 
much  safer  and  probably  more  stable  footing  than  ever 
before. 

The  methods  of  work  in  a  milk  laboratory  do  not  directly 
concern  us  here.  The  physician  writes  his  prescription  for 
the  composition  of  the  food  in  percentages  as  he  might  write 
for  a  medicine.  The  laboratory  prepares  the  former  with 
the  same  exactitude  as  the  skilful  pharmacist  dispenses  the 
latter.  The  points  of  direct  interest  are  that  the  milk  em- 
ployed is  of  the  best  type  of  "clean  milk,"  that  every 
manoeuver  in  the  dispensing  is  performed  with  care  for 
complete  scientific  cleanliness.  The  food  is  delivered  to  the 
consumer  precisely  as  ordered. 

The  comment  is  often  made,  rather  as  an  objection,  that 
the  laboratory  can  only  be  availed  of  by  those  living  in  or 
near  great  cities,  and  among  them  only  by  those  able  to 
spend  a  considerable  sum  for  the  infant's  food.  In  one 
sense  this  is  true,  and  in  another  not.  The  direct  use  of 
the  laboratory  is  in  effect  limited  to  those  described.  But 
the  wider  usefulness  of  the  laboratory  is  through  the  sug- 
gestions it  has  given  to  the  home  modifications  of  milk ;  and 
if  all  milk  laboratories  were  to  cease  their  operations  the 
lessons  they  have  taught  would  enable  physicians  every- 
where more  wisely  to  arrange  the  food  of  infants  under 
their  care. 

The  home  modification  of  milk  can  be  very  satisfactorily 
carried  out  by  any  intelligent  and  careful  person.  The 
principles  are  quite  simple,  and  may  be  applied  by  any 
one ;  careful  cleanliness  will  meet  all  the  details.  One  thing 
must  be  first  insisted  upon,  as  the  writer  has  very  fre- 
quently encountered  misapprehensions  on  this  point.     Milk 


90  THE  CENTURY  BOOK  FOR  MOTHERS 

modification  does  not  aim  at  making  an  infant  food,  but 
food  for  each  individual  infant.  If  a  milk  mixture  were 
compounded  to  contain  the  same  proportions  of  fat,  car- 
bohydrates, and  proteids  as  average  breast  milk  contains, 
it  might  suit  the  needs  of  more  infants  than  any  one  of 
the  many  foods  already  proposed ;  but,  after  all,  it  would  be 
only  one  other  "food."  The  aim  of  milk  modification  is  to 
provide  an  elastic  method  of  feeding,  so  that  the  propor- 
tion of  each  ingredient  may  be  without  difficulty  adjusted 
to  the  nutritional  and  digestive  needs  of  each  child.  The 
variable  digestive  power  of  different  infants  has  been  com- 
mented on,  as  well  as  the  fact  that  infants  seem  to  be  born 
Avith  digestions  adjusted  in  some  way  to  the  milk  of  their 
own  mothers.  It  would,  therefore,  scarcely  be  expected  that 
any  one  mixture  would  suit  every  young  infant.  It  is  the 
business  of  the  physician  to  be  familiar  with  the  details  of 
infant  feeding,  and,  in  case  of  necessary  weaning,  to  esti- 
mate the  needs  and  capacity  of  the  child  at  that  time,  and 
give  directions  how  the  food  shall  be  prepared  to  meet  them. 
If  his  judgment  leads  him  to  prefer  home  modification  of 
milk,  he  writes  no  prescription  to  be  filled,  but  he  probably 
has  one  in  mind,  the  working  details  of  which  he  gives  to 
the  mother  or  nurse  in  charge. 

How  are  these  details  worked  out?  It  is  not  strictly 
necessary  for  the  person  who  is  to  carry  them  out  to  know 
this,  but  it  will  enable  an  intelligent  mother  to  second  more 
efficiently  the  physician's  plans  if  she  does  know.  Still 
further,  sometimes  the  guidance  of  the  physician  is  not 
obtainable,  and  the  mother  must  work  by  herself.  Differ- 
ent physicians  may  arrive  at  a  conclusion  in  different  ways, 
but  the  essential  things  considered  are  these :  The  age  of 
the  child ;  its  condition  as  compared  with  the  average  infant 
of  that  age  as  regards  development,  digestive  peculiarities, 
aside  from  definite  illness;  and,  based  on  these  facts,  the 
composition  of  the  food  likely  to  suit ;  the  amount  of  it  to  be 
administered  at  one  time,  and  the  number  and  frequency  of 
the  feedings. 


FOOD  AND  FEEDING 


91 


VARYING    PROPORTIONS    IN   FEEDING 

The  quantity  may  be  advantageously  first  considered.  This 
has  been  carefully  estimated  by  a  good  many  accurate  ob- 
servers, using  somewhat  different  methods,  but  arriving  at 
results  so  nearly  the  same  as  give  them  a  good  deal  of 
authority.  The  main  factors  in  forming  an  opinion  are  the 
amount  which  the  stomach  of  the  infant  will  comfortably 
contain  at  different  ages  and  the  frequency  with  which  the 
stomach  must  be  refilled.     The  table  below  gives  a  pretty 


Age. 

Interval  in 
hoTirs  be- 
tween feed- 
ings in  day 
time. 

Number  of 
feedinscs  be- 
tween 10  p.m. 
and  7  a.m. 

Quantity  in 
ounces  at 
each  feed- 
ing. 

Total 
amount  in 
ounces  in 
24  hours. 

From  3d    day    to 
end  of  1st  week 

2 

10 

2 

1    toll 

10    to  12 

2d  and  3d  weeks .  . 

2 

10 

2 

U  "  2 

15    ''   20 

4th  and  5th  weeks 

2 

9 

1 

2i  "  3 

22i  *'   27 

6th  and  7th  weeks 

n 

8 

1 

3     ^'  4 

24    "   32 

8th    week     to    4 
months 

3 

7 

1 

4  increasing  to  5 

28    "   35 

4     months     to     8 
months 

3 

6 

0 

5         ''            ''7 

30    "   42 

8   months  to   one 
year 

3to3i 

5 

0 

7    to  9 

35    "   45 

good  estimate  of  the  amount  usually  required.  In  prepar- 
ing it  the  writer  has  made  use  of  his  own  experience,  and 
has  compared  his  results  with  the  tables  given  in  several 
of  the  more  recent  text-books,  some  of  which  are  very  simi- 
lar and  therefore  confirm  the  writer  in  his  estimates. 

It  is,  of  course,  to  be  understood  that  one  child  may  actu- 
ally need  more  than  another,  hence  a  little  variation  in  quan- 
tity is  provided  for.  If  it  is  necessary  to  increase,  let  it— 
in  a  healthy  child— be  done  by  increasing  the  amount  in 
each  feeding,  not  by  diminishing  the  interval  between  feed- 
ings.    The  stomach  of  the  child  must  have  its  proper  rest. 


92        THE  CENTURY  BOOK  FOR  MOTHERS 

In  some  cases  it  is  possible  to  get  on  with,  but  one  night 
feeding  from  the  first,  and  if  the  infant's  habits  of  sleep 
favor  this  plan  it  is  to  be  encouraged,  but  two  feedings  are 
allowed  during  the  first  few  weeks  as  being  more  commonly 
called  for.  But  the  giving  the  breast  or  bottle  more  fre- 
quently, or  the  continuance  of  two  night  feedings  for  a 
child  several  months  old,  is  distinctly  reprehensible.  The 
quantity  for  the  single  feeding  would  better  be  kept  at  or 
near  the  lower  figure  given  for  that  age,  and  not  raised, 
unless  it  be  quite  evident  that  the  amount  given  is  insuffi- 
cient. Some  observers  hold  that  heavier  children  require 
more  than  lighter  ones.  It  may  possibly  be  so,  but  to  the 
writer  it  has  seemed  that  thin  infants,  those  born  so,  have 
at  least  as  eager  appetites  and  make  as  large  demands  as 
fat  babies.  In  any  case,  the  advice  just  given  would  better 
be  borne  in  mind,  as  in  artificial  feeding  the  tendency  to 
give  too  large  a  quantity  is  almost  universal.  If  a  child  is 
happy  and  makes  satisfactory^  gains  in  weight  and  devel- 
opment, the  amount  should  be  increased  with  circumspec- 
tion. It  will  be  noticed  that  the  increase  in  volume  of 
daily  food  is  more  rapid  at  first  than  later.  But  it  A\dll 
presently  be  seen  that  the  composition  of  the  food  also  pro- 
gressively changes,  so  that  while  the  amount  of  liquid  is  not 
greatly  enlarged  the  amount  of  solids,  especially  of  proteids, 
contained  in  the  liquid  is  considerably  increased. 

How  shall  we  be  guided  in  planning  the  change  in  the 
solid  constituents?  There  is  but  little  change  in  them  in 
breast  milk  during  the  course  of  suckling,  and  our  ideas  as 
to  the  proportions  are  the  result  of  observation  as  to  the 
mixtures  which  in  practice  do  best  agree  with  infants  de- 
prived of  the  natural  supply.  We  need  enter  into  no  spec- 
ulation as  to  why  the  breast  milk  may  be  satisfactory  with- 
out change  in  composition  for  so  long  a  time.  For  our 
purposes  it  need  only  be  remembered  that  the  infant,  in 
taking  artificial  food,  even  if  made  from  cow's  milk,  is  tak- 
ing nutritive  elements  which  are,  for  it,  far  less  digestible 
than  those  of  its  mother's  milk.     The  mixtures  advocated 


FOOD  AND  FEEDING  93 

by  the  most  experienced  workers  in  this  line  at  the  present 
time  have  been  largely  wrought  out  by  starting  with  certain 
ones  approximating  breast  milk  in  chemical  proportion,  and 
carefully  adjusting  them  experimentally  to  meet  digestive 
difficulties  as  they  arise.  In  other  words,  physiology  has 
built  upon  a  substructure  of  chemistry. 

As  a  matter  of  fact,  therefore,  mixtures  are  first  made  of 
a  lower  percentage  of  proteids  and  fats  than  is  found  in 
mother's  milk,  and  not  until  the  child  is  three  or  four 
months  old  is  its  food  so  strong  by  analysis  as  the  breast 
milk.  Such  a  method  seems  to  give  the  best  results.  Thus, 
a  child  in  the  first  month  would  not  reach  a  proteid  per- 
centage of  one  per  cent.  It  would  begin  in  the  first  week 
with  perhaps  not  much  above  one  half  of  one  per  cent.,  and 
go  up  to  three  fourths.  The  fat  per  cent,  would  be  only 
about  two  per  cent.,  or  one  half  that  of  breast  or  cow's  milk, 
which  we  have  assumed  to  be  four  per  cent.,  and  so  on. 
Of  course,  at  such  an  age  the  monthly  nurse  would  prob- 
ably still  be  in  attendance,  and  the  physician  would  direct 
the  mixture  of  the  food  and  the  mother  would  be  spared  the 
trouble. 

Let  us  suppose,  however,  that  the  mother  were  obliged, 
when  the  child  was  two  months  old,  to  make  a  food  herself 
which  would  supplement  wholly  or  partly  her  failing  breast 
milk.  The  table  (page  91)  gives  about  twenty-four  ounces, 
or  a  pint  and  a  half,  as  the  daily  amount  required  for  a 
child  wholly  artificially  fed,  to  be  given  in  meals  of  about 
four  ounces  each.  This  amount  (four  ounces),  then,  is  to  be 
given  at  the  hours  when  suckling  should  take  place,  provided 
the  breast  cannot  afi^ord  the  meal,  and  as  many  times  in  the 
twenty-four  hours  as  the  breast  fails. 

BOTTLES,   NIPPLES,   AND   MEASURES 

Before  mixing  the  food  the  necessary  outfit— bottles,  nip- 
ples, etc.— must  be  procured. 

Of  bottles,  the  most  convenient  are  those  graduated  with 


94        THE  CENTURY  BOOK  FOR  MOTHERS 

ounce  marks,  since  they  may  be  filled  to  the  desired  mark 
without  other  measuring.  They  should  be,  if  procurable, 
straight-sided,  with  rounded  bottoms  and  wide  mouths,  as 
these  are  the  easiest  to  keep  clean. 

The  rubber  nipples  should  fit  immediately  upon  the  wide 
neck  of  the  bottle.  No  tubes  are  to  be  permitted;  they  are 
only  secreters  and  harborers  of  dirt. 

The  nipples  should  have  as  small  holes  as  the  child  can 
draw  the  liquid  through  without  fatigue.  Dr.  Holt  sug- 
gests holes  "large  enough  for  the  milk  to  drop  rapidly  when 
the  bottle  is  inverted,  but  not  so  large  that  it  will  run  in 
a  stream."  The  writer  often  finds  it  most  convenient  to 
pick  out  unperforated  nipples  and  perforate  them  with  a 
fine  needle  until  the  desired  flow  is  obtained.  Plain  black 
rubber  nipples  are  the  best.  Some  prefer  the  conical  shape, 
but  the  slightly  bulbous  ones  seem  to  give  less  trouble  to 
some  children,  and  as  the  nipple  is  turned  inside  out  in 
cleaning  there  is  really  no  choice  as  regards  cleanliness. 

The  bottles  and  nipples  are  to  be  cleansed  thoroughly  with 
hot  water  and  soap  or  soda  (any  good  washing  alkali  will 
serve),  and  then  well  rinsed  in  clear  water.  It  is  best  that 
they  be  boiled  before  using.  Afterward,  immediately  after 
each  using  they  should  be  thoroughly  rinsed  and  cleansed 
by  means  of  hot  water,  soap  or  an  alkali,  and  always  steril- 
ized by  boiling  before  being  filled.  It  is  a  good  plan  to 
keep  the  bottles  between  the  time  of  cleaning  and  sterilizing 
filled  with  water,  as  this  prevents  any  overlooked  matter  from 
drying  on  the  glass,  which  then  might  be  difficult  of  re- 
moval. Nipples  are  also  to  be  rinsed  carefully  inside  and 
out  after  using,  and  kept  in  a  cup  or  bowl  of  a  solution  of 
borax  or  boric  acid  in  water,  say  a  teaspoonful  of  either 
powder  to  a  half  pint  of  water.  For  cleansing  bottles  a  bot- 
tle-brush is  necessary. 

An  accurate  measure  for  milk  and  water  is  necessary. 
The  druggists'  graduate  is  the  most  convenient  one,  but  if 
it  be  not  easily  procured  any  glass  can  be  utilized  by  filling 
it  with  water  measured  in  a  tablespoon— it  being  remembered 


FOOD  AND  FEEDING  95 

that  a  tablespoon  holds  half  an  ounce— and  this  glass  of 
known  capacity  be  kept  as  a  measure.  For  measuring  milk- 
sugar  the  most  convenient  contrivance  is  a  druggist's  pill 
or  powder-box,  carefully  trimmed  until  it  will,  when  even- 
full,  hold  just  one  ounce  of  milk-sugar. 

THE   SEPARATION   OF  CREAM 

All  the  required  utensils  being  ready,  a  quart  bottle  of 
the  best  obtainable  milk  is  provided,  and  is  placed  in  the 
refrigerator  while  the  cream  rises,  so  that  the  top-milk  already 
spoken  of  may  be  used.  At  the  end  of  six  hours  sufficient 
separation  of  the  cream  has  usually  taken  place.  If  from 
the  quart  the  upper  third  be  carefully  taken  it  is  probable 
that,  if  the  milk  has  been  of  good  quality,  the  top-milk 
would  have  a  fat  percentage  of  about  ten.  If  the  upper 
eight  ounces  were  taken,  the  fat  percentage  would  be  still 
higher,  and  if  only  the  top  six  ounces  be  taken  it  is  pretty 
certain  to  contain  as  much  as  twelve  per  cent,  of  fat.  With 
all  these  various  fat  percentages  the  proportion  of  proteids 
and  of  sugar  and  salts  will  vary  very  little  from  that  of 
the  milk  itself.  The  process  of  raising  the  cream  has  given 
us  practically  only  a  superfat  milk. 

VARIOUS   MIXTURES 

If  it  be  desired  to  give  the  two-months'  baby  a  mixture 
containing,  say,  three  per  cent,  of  fat,  six  per  cent,  of  sugar, 
and  one  per  cent,  of  proteids,  which  would  in  fact  be  about 
what  a  good  physician  probably  would  propose,  how  is  this 
accomplished?  The  six  ounces  of  top-milk  we  assumed  to 
contain  twelve  per  cent,  of  fat,  four  of  sugar,  four  of  pro- 
teids. If  to  it  three  parts,  or  eighteen  ounces,  of  water  be 
added,  the  desired  twenty-four  ounces  of  mixture  is  gained,, 
which  will  contain  three  per  cent,  of  fat,  one  per  cent,  of 
sugar,  one  per  cent,  of  proteids,  and  a  proportionate  dilu- 
tion of  the  salts.     To  bring  up  the  sugar  value  to  the  six 


96  THE  CENTURY  BOOK  FOR  MOTHERS 

per  cent,  aimed  at,  the  difference,  five  per  cent.,  must  be 
added  as  milk-sugar,  or,  in  its  absence,  as  white  cane-sugar. 
Five  per  cent,  of  twenty-four  ounces  is  one  and  one  fifth 
ounces.  This  amount,  therefore,  is  to  be  added  to  the  mix- 
ture and  dissolved.  Two  things  are  yet  to  be  corrected— 
viz.,  the  amount  of  salts  and  the  acidity;  for  while  breast 
milk  is  alkaline  in  reaction,  cow's  milk  is  nearly  always  acid, 
and  as  it  comes  to  the  consumer  practically  always  so,  this 
reaction  can  be  changed  by  the  addition  of  lime-water,  five 
per  cent,  being  usually  enough,  and  at  the  same  time  the  lime- 
water  in  a  large  degree  makes  good  the  deficiency  of  salts 
due  to  the  dilution  of  the  top-milk. 

Similarly,  if  it  were  desired  to  give  to  a  child  of  seven 
months  forty  ounces  of  food,  which  should  contain,  fat, 
four  per  cent.,  sugar,  seven  per  cent.,  and  proteids,  two  per 
cent,  (that  is  to  say,  the  equivalent  of  a  pretty  rich  breast 
milk),  it  would  be  most  easily  made  by  diluting  with  an 
equal  volume  of  water  twenty  ounces  of  top-milk,  which 
should  have  an  eight-per-cent.  fat  value.  Such  a  milk  can 
be  approximately  procured  by  taking  the  upper  twelve 
ounces  from  a  quart  of  milk,  and  the  remaining  eight  ounces 
necessary  from  two  thirds  of  a  quart  set  to  raise  the  cream 
in  another  bottle.  Or  the  whole  might  be  set  in  one  proper, 
well-covered  vessel.  After  dilution,  the  sugar  value  would 
be  two  per  cent.,  and  five  per  cent,  of  milk-sugar  Avould  be 
again  necessary;  in  this  case,  five  per  cent,  of  forty  ounces, 
or  two  ounces.     Lime-water  is  to  be  added  as  before. 

These  methods  have  to  be  varied  indefinitely  for  differ- 
ent ages,  different  children,  different  conditions.  When- 
ever medical  guidance  is  obtainable,  it  is  safer  to  follow  it. 
When  it  cannot  be  had,  the  mother  should  remember  that 
it  is  safer  to  use  a  dilute  food,  and  give  more  of  it  if 
necessary,  than  to  burden  the  digestion  with  too  heavy  a 
mixture. 

In  all  mixtures  the  water  used  should  have  been  boiled, 
unless  the  food  is  to  be  sterilized. 

It  is  a  disputed  point  whether  or  not  the  use  of  barley- 


FOOD  AND  FEEDING  97 

water  as  a  diluent  instead  of  simple  water  renders  the 
curds  formed  in  the  digestive  organs  less  hard  and  tough. 
Nevertheless,  the  belief  that  the  various  cereal  waters  or 
gruels  do  have  this  action  is  quite  general,  and  there  is,  in 
the  writer's  judgment,  no  objection  to  their  use,  and  pos- 
sibly some  advantage  therein,  if  they  be  used  thin  enough 
to  be  diluents  only.  The  objection  to  thicker  gruels  is 
the  amount  of  unchanged  starch  which  they  may  contain, 
which  is  beyond  the  digestion  of  quite  young  infants.  This 
difficulty  it  is  proposed  by  some  to  remove  by  first  converting 
the  starch  by  some  diastatic  substance. 


FEEDING   CONVENIENCES 

It  may  be  proper  to  here  mention  one  or  two  conveniences 
in  the  preparation  of  the  food.  The  first  is  a  dipper  con- 
trived by  Dr.  Chapin  for  removing  the  cream  or  the  milk,  or 
both,  as  desired,  from  the  bottle  without  mixing  them.  It 
consists  of  a  little  tin  bucket  with  an  upright  handle  of  stout 
wire.  The  dipper  holds  an  ounce,  and  can  be  thrust  into  the 
mouth  of  the  bottle  to  any  desired  level  and  withdrawn  full 
with  very  little  disturbance  of  the  contents  of  the  latter.  By 
its  use  any  desired  number  of  ounces  may  be  removed  from 
the  bottle.  Without  such  a  contrivance  the  cream  must  be 
removed  with  a  teaspoon,  the  bottle  being  slightly  and  gradu- 
ally tilted  to  allow  the  use  of  the  spoon.  A  better  way  is 
to  use  a  glass  siphon  to  remove  the  milk  from  below  until 
only  the  desired  amount  of  top-milk  is  left  in  the  bottle. 
Where  milk  is  set  to  rise  in  a  pan,  the  latter  should  be  cov- 
ered, a  measured  quantity  only  of  milk  being  in  it.  From 
the  top  the  desired  number  of  ounces  can  be  easily  skimmed 
or  dipped. 

The  other  contrivance  is  a  sort  of  measuring-glass,  upon  the 
different  sides  of  which  are  blown  marks  showing  the  amounts 
of  the  various  ingredients  of  modified  milk  mixtures  in  com- 
mon use  at  different  ages.  If  it  be  kept  constantly  in  mind, 
as  has  been  before  insisted  upon,  that  neither  these  nor  any 
7 


98  THE  CENTURY  BOOK  FOR  MOTHERS 

other  mixtures  are  fixed,  but  tentative,  the  apparatus  will  be 
found  convenient  in  the  mixing  of  food.  The  effects  of  a 
food  mixture,  however  and  by  whomsoever  mixed,  are  to  be 
watched,  and  its  proportions  retained  or  altered  according  as 
the  mixture  seems  to  meet  the  requirements. 

Whatever  the  mixture  that  has  been  mixed,  it  is  divided 
into  the  requisite  number  of  sterilized  bottles,  each  con- 
taining the  amount  of  food  intended  for  one  meal.  If  a 
child  well  along  in  its  first  year  requires  more  food  than 
one  nursing-bottle  will  hold,  the  amount  for  one  meal  may 
be  divided  between  two  bottles.  But  a  bottle  once  opened 
for  use  must  not  be  "warmed  over."  Thus,  if  a  child  re- 
quires twelve  ounces  at  a  meal  and  eight-ounce  bottles  are 
the  largest  obtainable,  it  is  better  to  put  six  ounces  into  the 
bottles  and  to  use  two  than  to  use  one  bottle  and  part  of 
another,  keeping  the  other  part  to  eke  out  the  next  meal. 

If  the  food  is  not  to  be  sterilized,  the  bottles  should  at  once 
be  tightly  stopped  with  absorbent  cotton  and  placed  in  the 
ice-box.  When  one  is  needed  it  is  taken  from  the  ice-box, 
placed  in  warm  water  until  the  food  is  blood-warm,  when  the 
stopper  is  removed  and  the  nipple  is  placed  upon  the  bottle 
and  the  food  given.  It  is  better  to  hold  the  child  while  it 
takes  the  bottle,  or  at  least  to  hold  the  bottle  so  that  the  food 
shall  be  always  at  the  nipple-end  of  the  former,  and  the  child 
not  be  sucking  upon  an  air-chamber  instead  of  its  food. 

STERILIZATION 

Shall  the  food  be  sterilized?  Sterilizing  in  the  full  sense 
is  done  by  raising  the  contents  of  the  bottles  to  the  tem- 
perature of  boiling  water — 212°  F.  Pasteurizing  is  the 
name  given  to  sterilizing  at  a  lower  temperature — 167°  F. 
ordinarily.  Food  may  be  sufficiently  Pasteurized  for  safe- 
keeping for  a  day  at  still  lower  temperatures.  Various 
sterilizers  and  Pasteurizers  are  in  common  use. 

If  the  food  be  promptly  made  from  a  milk  answering  the 
requirements  of  "clean  milk,"  already  discussed,   all  the 


FOOD  AND  FEEDING  99 

manipulations  being  quickly  done  with  every  precaution 
and  the  food  kept  on  ice,  it  is  likely  that,  under  ordinary 
circumstances,  sterilization  is  unnecessary  and,  if  so,  unde- 
sirable. But  in  all  cases  where  any  doubt  exists  as  to  mate- 
rials, methods,  or  surroundings,  it  is  far  safer  to  Pasteurize 
or,  if  necessary,  sterilize  the  food.  If  one  of  the  well-known 
forms  of  apparatus  be  procured,  full  directions  are  given 
with  it.  In  the  absence  of  an  apparatus,  any  culinary  steam- 
ing utensil  may  be  used  for  sterilization. 

One  thing  should  be  mentioned.  If  food  is  to  be  sterilized, 
the  lime-w^ater  should  be  added  to  each  bottle  after  and  not 
before  the  steaming,  as  in  the  latter  case  a  change  takes  place, 
somewhat  discoloring  the  mixture. 

Other  admissible  foods. during  the  latter  part  of  the  first 
year  are  certain  preparations  made  from  cereals  and  from 
meat.  The  word  admissible  is  used  because  it  seems  to  the 
writer  that  during  the  first  year  they  are  not  really  called 
for  in  health.  In  cases  where  casein  cannot  be  digested  or 
for  any  other  reason  milk  must  be  temporarily  set  aside  these 
preparations  are  useful.  In  many  other  cases  they  seem 
acceptable  to  the  child.  Nevertheless,  the  ordinary  occa- 
sion for  their  use  during  the  first  year,  so  far  as  the  writer's 
experience  goes,  is  that  for  some  reason  the  mother  thinks 
the  baby  ''ought  to  have  stronger  food."  Although  these 
articles  in  any  form  which  an  infant  can  digest  are  not  com- 
parable in  nutritive  value  to  milk,  they  do  for  some  reason 
appeal  to  the  imagination  as  stronger  food. 

GRUELS 

The  forms  of  cereals  permitted  are  decoctions,  the  best 
known  being  barley-water  or  oatmeal-water  or  gruel  or, 
formerly  more  than  now,  arrowroot  gruel.  The  latter  had 
great  repute  in  bowel  troubles  for  young  and  old,  but  at 
the  present  time  the  barley  and  oatmeal  preparations  are 
in  general  use.  Keceipts  for  gruels  very  acceptable  to  adult 
invalids  are  found  in  most  cook-books,  but  the  oatmeal  or 


100       THE  CENTURY  BOOK  FOR  MOTHERS 

barley-water  used  for  mixing  with  the  infant's  food  must 
be  considerably  thinner  than  these  preparations  if  the  first 
experiments  in  the  digestion  of  starch  are  to  be  made  at  the 
age  of  eight  or  nine  months.  The  making  of  barley-water 
from  the  whole  grain  is  so  tedious  a  process  that  it  is  better 
to  use  some  good  preparation  of  barley,  in  flour-form  pre- 
ferred. If  none  can  be  readily  procured  the  cleansed  grain 
can  be  ground  finely  in  a  coffee-mill,  which  should  of  coui'se 
be  first  freed  from  all  traces  of  coffee.  Of  these  finely 
ground  preparations  about  three  teaspoonfuls  should  be 
boiled  for  at  least  a  quarter,  better  a  half,  of  an  hour  in 
a  pint  of  water.  The  liquid  is  then  strained  through  a 
fine  strainer,  preferably  a  cloth.  It  is  used  as  a  diluent 
of  milk  instead  of  an  equal  bulk  of  water.  Oatmeal  is  sup- 
posed to  be  more  laxative  than  barley,  and  is  used  for  gruel 
in  cases  of  constipation.  The  various  previously  cooked 
preparations  of  oatmeal  on  the  market  render  the  making 
of  the  gruel  easier  than  it  formerly  was.  Time  is  gained 
if  even  these  are  ground  as  recommended  for  barley.  In 
cases  of  emergency  a  gruel  can  be  made  from  oatmeal  por- 
ridge by  boiling  a  tablespoonful  of  it  in  a  pint  of  water 
and  straining  as  before. 

Gradually  the  strength  of  these  gruels  is  increased  by  the 
use  of  a  larger  amount  of  the  cereal  to  a  given  amount  of 
water. 

BROTHS   AND   MEAT  JUICE 

The  meat  preparations  admissible  are  broths,  beef-tea,  and 
beef-juice.  They  differ  in  food  value,  as  well  as  in  the 
uses  they  are  best  adapted  to.  Thus,  in  beef-juice  or  in 
beef-tea  a  larger  percentage  of  proteids  will  be  found  than 
in  broth,  but  inasmuch  as  in  making  broth  or  beef-tea  the 
amount  of  liquid  obtained  is  much  larger  than  from  squeezed 
beef,  the  total  amount  of  proteids  obtained  from  a  given  piece 
of  meat  would  be  best  if  the  beef-juice  method  be  employed. 
There  are,  however,  in  all  meat  preparations,  such  as  those 
mentioned,  a  group  of  substances  called  extractives,  to  many 


FOOD  AND  FEEDING  101 

of  which  names  have  been  given,  the  most  familiar  being 
creatin  and  creatinin.  To  these  substances  is  due  most  of 
the  agreeable  odor  and  taste  of  meats.  They  are  not  nutri- 
tious in  the  ordinary  sense  of  that  word,  but  they  do  have  a 
peculiar  effect  which  may  be  described  as  stimulating. 
Every  one  who  has  kept  a  cat  or  dog  has  probably  observed 
the  exciting  effect  of  meat  diet,  if  given  in  large  quantity, 
as  compared  with  an  equal  amount  of  nutriment  from 
bread,  vegetables,  or  even  from  milk.  Chemists  tell  us  also 
that  these  extractives  seem  to  prevent  waste,  while  they  do 
not  repair  it.  These  facts  hint  at  the  condition  under  which 
the  meat  preparations  are  useful— when,  namely,  the  appe- 
tite for  milk  flags  or  a  stimulant  seems  called  for.  When 
considered  as  nutriment,  these  meat  preparations  and,  above 
all,  meat-juice,  are  not  economical,  as  compared  with  other 
foods.  On  the  other  hand,  the  meat- juices,  owing  to  the 
greater  amount  of  extractives  in  them,  are  the  most  stimu- 
lating. The  amount  of  juice  obtainable  from  a  given  weight 
of  meat  will  vary  with  the  piece,  the  juiciest  giving  not  more 
than  one  fifth  of  the  weight  of  the  meat,  and  often  not  more 
than  an  eighth  can  be  obtained.  In  the  latter  case  a  half 
pound  of  meat  will  give  about  two  tablespoonfuls  of  juice. 
In  beginning  its  use  in  the  first  year,  not  more  than  half  a 
tablespoonful  should  be  given  at  first,  and  only  once  a  day. 
If  well  borne  it  may  be  increased  gradually,  but  carefully. 
It  is  to  be  understood  that  what  is  said  of  meat  includes 
several  kinds,  especially  those  in  common  use  for  children's 
broths— beef,  mutton,  and  chicken.  For  squeezing,  beef  is 
most  convenient,  as  also  for  the  more  concentrated  ''tea." 
For  making  broth,  however,  mutton  and  chicken  are  quite 
as  valuable  and  give  a  variety,  which  later  on  is  more  de- 
sirable than  at  the  age  we  are  discussing.  i 

THE   SECOND   YEAR 

In  the  second  year,  and  indeed  for  some  years  afterward, 
milk  must  remain  the  chief  article  of  a  child's  diet.     While 


102  THE  CENTtm^   BOOK  FOR  MOTHERS 

some  physicians  advise  that  a  child  a  year  old  should  have 
whole  milk,  and  while  it  is  true  that  some  children  can 
at  that  age  digest  it,  nevertheless  the  writer  is  convinced 
that  it  is  not,  as  a  rule,  wise  to  give  it.  In  fact,  so  far 
as  his  experience  goes,  a  year  and  a  half  seems  a  better 
time  than  earlier  to  cease  the  dilution  of  milk  entirely.  He 
believes  that  it  will  be  found  more  judicious  to  give  a  larger 
quantity  of  diluted  milk,  if  it  seems  to  be  required,  than  to 
unduly  hasten  the  increased  proportion  of  proteids,  as  must 
be  the  case  if  a  diet  of  whole  milk  is  given  too  early.  Now, 
if  it  is  borne  in  mind  that  the  progress  is  from  a  food  of 
high  sugar  and  low  proteid  values,  to  represent  breast  milk, 
toward  cow's  milk,  which  contains  nearly  equal  proportions 
of  sugar  and  proteids  and,  if  of  good  quality,  of  fats  also, 
it  A\dll  be  at  once  seen  that  we  have  still  to  dilute  the  pro- 
teids with  some  water  and  to  bring  up  the  other  solids  by 
the  addition  of  some  cream  and  some  sugar.  The  propor- 
tion of  proteids,  probably  at  twelve  months,  should  have  gone 
up  to  about  three  per  cent.,  while  the  fat  may  have  come 
down  nearly  to  the  proportion  of  cow's  milk,  and  the  sugar 
nearly  as  much — let  us  say  four  per  cent,  for  fat  and  five 
per  cent,  for  sugar.  The  desired  proportion  of  proteids 
(three  per  cent.)  could  be  easily  obtained  by  adding  one 
part  of  water  to  three  of  milk,  but  inasmuch  as  the  cream 
with,  which  Ave  shall  restore  the  fat  value  contains  proteids, 
we  must  allow  for  this  by  the  first  use  of  more  water — 
say  one  part  of  water  to  two  of  milk.  This  has  brought  the 
proteids  down  to  about  2.7  per  cent.  The  addition  to  this 
of  about  one  ninth  part  in  bulk  of  good,  hand-skimmed 
cream  (fifteen  to  twenty  per  cent.,  according  to  the  dex- 
terity of  the  skimmer)  will  bring  up  both  proteids  and  fat 
to  the  desired  figures.  Now,  as  it  is  probable  that  our  year- 
ling will  desire  about  ten  ounces  at  a  meal,  the  above  pro- 
portions would  call  for  six  ounces  of  milk,  three  of  water, 
and  one  of  the  hand-skimmed  cream.  If  separated  cream 
be  bought  it  can  be  had  of  sixteen  per  cent,  strength  at 


FOOD  AND   FEEDING  103 

laboratories  and  at  some  dairies.  The  mixture  is  still  short 
of  sugar,  the  ten-ounce  meal  requiring  about  two  drams 
(one  hundred  and  twenty  grains)  to  raise  it  to  a  five-per-cent. 
sugar  strength.  In  default  of  scales,  a  level  dessertspoonful 
or  two  level  teaspoonfuls  wdll  give  this  amount  accurately 
enough. 

Such  a  mixture  is  gradually  approximated  to  the  strength 
of  pure  milk  by  diminishing  the  amount  of  water,  cream, 
and  sugar  in  the  ten-ounce  mixture  and  making  the  re- 
mainder of  it  of  whole  milk  until  no  modification  is  deemed 
necessary. 

THE   FEEDING   OF   OLDER  CHILDREN 

Of  course,  the  milk  or  the  mixture  must  still  be  given 
blood-warm,  or  at  the  very  least  the  chill  must  be  taken 
from  it.  Milk  at  refrigerator  temperatures  is  unfit  for  young 
children.  As  has  been  already  mentioned,  the  number  of 
feedings  in  a  day  (twenty-four  hours)  is  usually  to  be  re- 
duced to  five  by  the  age  of  nine  or  ten  months,  certainly 
before  the  end  of  the  first  year.  The  amount  of  food  taken 
at  a  meal  will  during  the  second  year  be  gradually  in- 
creased from  eight  to  ten  ounces — if,  indeed,  the  increase  has 
not  been  begun  before  the  end  of  the  first  year.  The  daily 
amount  of  milk  food  will  therefore  be  gradually  increased 
from  forty  to  fifty  ounces.  But  it  must  always  be  remem- 
bered that  whenever  a  meal  includes  other  articles  of  food 
the  amount  of  milk  at  that  meal  must  be  proportionally 
diminished,  especially  if  the  additional  food  be  of  animal 
origin  (meat,  eggs,  etc.).  Experience  has  sho^\Ti  that  the 
evening  meals  are  best  borne  if  rather  light,  hence  increase  or 
changes  in  diet  should  not  be  made  after  midday,  and  prob- 
ably, from  convenience  rather  than  from  any  hygienic  reason, 
the  middle  meal  of  the  day,  rather  than  an  earlier  one,  is  usu- 
ally the  one  at  which  the  articles  of  food  other  than  milk 
are  given,  and  is  often  called  the  baby's  dinner.  A  little 
later  suggestions  will  be  given  as  to  feeding  schedules. 


104  THE  CENTURY  BOOK  FOR  MOTHERS 

DIGESTIBILITY  OF  FOOD 

As  new  articles  of  food  are  introduced  into  the  dietary, 
it  is  well  to  keep  in  mind  the  objects  of  each  one— that  is 
to  say,  to  remember  that  it  is  still,  and  will  always  be, 
necessary  to  keep  a  proper  balance  between  the  nutritive 
elements— the  proteids,  fats,  carbohydrates,  and  salts— in 
the  food  given.  Their  relation  to  the  milk  given  is  a  part  of 
this  consideration.  The  nutritive  value  is  not  the  only  cri- 
terion of  food ;  digestibility  is,  in  childhood  at  least,  scarcely 
less  important.  The  articles  of  food  besides  milk  admitted 
to  the  dietary  of  the  second  year  are  usually  meats,  eggs, 
cereal  porridges,  bread  and  butter,  and  fruits.  From  the 
meat  and  eggs  proteids  and  fats  are  obtained.  The  por- 
ridges and  bread  are  very  largely  composed  of  carbohydrates 
in  the  form  of  starch,  changed  or  unchanged,  but  oatmeal 
and  whole-wheat  flour  contain  considerable  proteids.  But- 
ter is  practically  all  fat,  while  fruits  furnish  mainly  sugar 
and  salts.     Salts  are  present  in  nearly  all  articles  of  food. 

THE  CHEWING  TEETH 

During  the  first  half  of  the  second  year  the  child  is  get- 
ting its  first  molars,  mthout  which  it  can  do  no  chewing, 
and,  as  before  stated,  its  milk  food  is  approaching  the  com- 
position of  whole  milk.  Until  it  can  chew  the  child  can 
rarely  digest  any  solid  food.  Hence  the  additions  to  the 
milk  diet  must  practically  consist  of  the  meat- juices  and 
broths  already  spoken  of,  and  gruels  from  which  all  coarse 
particles  are  strained  out. 

MEAT  AND   EGGS 

With  the  completion  of  this  first  half  of  the  second  year 
the  chewing  teeth  are  probably  present,  and  the  power  to 
digest  starch  and  flesh  is  in  some  degree  gained.  This  power 
of  digestion  does  not,  of  course,  depend  upon  the  presence 


FOOD  AND  FEEDING  105 

of  the  teeth,  but  these  two  stages  of  development  do  on 
the  average  coincide  sufficiently  nearly  to  allow  us  to  infer 
the  one  from  the  existence  of  the  other.  Hence  at  eighteen 
months  we  may  venture  to  give  meat  and  eggs.  Since  the 
art  of  chewing  has  not  been  learned,  the  meat,  beef  or  mut- 
ton, must  be  carefully  scraped  from  the  pulp  of  a  piece  of 
rare-done  steak,  chop,  or  roast,  all  tough  fibers  being  dis- 
carded. A  good  teaspoonful  of  juicy  pulp  is  enough  to 
begin  with,  and  a  tablespoonful  should  be  the  limit  of  a 
day's  ration  during  the  second  year.  If  the  child  seems  to 
digest  the  meat  well,  an  egg  may  be  tried.  It  should  be 
really  fresh  and  lightly  boiled  and  slightly  salted.  Of 
course,  the  meat  and  egg  cannot  be  given  on  the  same  day, 
and  the  latter  should  not  be  given  oftener  than  twice  a  week, 
so  that  its  acceptability  to  the  digestion  can  be  noted.  With 
the  meat  or  with  the  egg  it  is  best  to  give  some  bread.  Chil- 
dren usually  like  bread-crumb  with  meat-juices  or  eggs. 
Whether  for  crumbing  or  for  eating  with  butter,  the  bread 
should  be  distinctly  stale,  or  it  may  be  dried  to  the  condi- 
tion of  ''oven  toast"— -i.  e.,  a  thin  slice  of  bread  placed  in 
the  slow  oven  until  it  assumes  a  golden-brown  color.  Until 
the  chewing  art  is  fairly  obtained,  the  greater  part  of  the 
bread  would  better  be  crumbed.  The  child  can  learn  to 
masticate  the  mixture  of  crumb  and  scraped  meat  or  crumb 
and  egg  without  danger  of  large  pieces  being  swallowed. 

ZWIEBACK  AND  CRACKERS 

Zwieback  is  much  used  for  children  in  place  of  bread. 
It  is  preferable  to  fresh  pasty  bread,  but  so  far  as  we  can 
see  has  no  advantages  over  the  "oven  toast"  above-men- 
tioned, save  that  it  is  ready-made.  This  is  a  doubtful  ad- 
vantage. It  has  the  disadvantage  of  being  usually  sweet- 
ened. Being  ready-made,  it  would  better  be  heated  in  the 
oven  before  serving,  a  remark  which  also  applies  to  most 
crackers  or  biscuit. 

These  crackers  are  also  much  used  for  children,  probably 


106        THE  CENTURY  BOOK  FOR  MOTHERS 

originally  from  convenience,  in  many  families  in  which  the 
bread-making  art  was  not  well  developed  and  the  hot-bread 
habit  well  established.  Of  the  many  kinds  of  biscuit  or 
crackers  in  use,  a  few  are  wholesome,  more  undesirable,  and 
some  objectionable  for  children.  Those  made  of  whole 
wheat  are  best,  as  they  have  other  elements  of  the  grain 
beside  the  starch.  A  biscuit  of  this  type  much  sold  in  the 
Eastern  States  is  called  the  "Educator  Wafer."  In  choos- 
ing from  those  made  of  white  flour,  those  which  are  light, 
free  from  grease,  and  free  from  sweetening  are  to  be  selected. 
They  should  be  firm  enough  to  require  quite  a  little  chew- 
ing, and  not  hard  enough  to  be  beyond  the  child's  chewing 
powers.  Thus,  soft  powdery  crackers,  which  are  simply  mois- 
tened with  a  little  saliva  and  swallowed  or  washed  down 
with  a  gulp  of  water,  are  objectionable  on  the  one  hand.  The 
very  hard  water-crackers  or  educators  (not  the  ''wafer"), 
although  very  desirable  for  adults  are,  on  the  other  hand, 
for  young  children  too  difficult  eating.  Sweetened  biscuits 
are  objectionable,  partly  because,  in  this  country  at  least, 
most  children  eat  a  very  unnecessary  and  undesirable 
amount  of  sugar,  and  still  more  because  a  habit  is  begotten 
which  leads  children  to  refuse  all  food  which  is  not  dis- 
tinctly flavored  with  sugar  or  in  some  other  way. 


GRUELS  AND   PORRIDGES 

In  connection  with  the  bread  we  may  mention  cereal  prep- 
arations. Porridges  as  prepared  for  adults  are  rarely 
within  the  digestive  abilities  of  a  child  under  two  years 
of  age,  and  the  coarser  particles  should  still  be  strained  out 
and  the  mixture  thinned  with  warm  milk  to  a  gruel-like 
consistency  and  seasoned  with  salt.  Neither  gruels  nor  por- 
ridge, in  the  writer's  opinion,  should  ever  be  eaten  with 
sugar.  When  the  starch-converting  power  of  the  digestion 
is  developed  sugar  enough  is  manufactured  from  the  starch 
that  is  taken  in  bread,  cereals,  etc.  Before  that  time  milk 
furnishes  sugar  enough  for  the  child's  wants,  and  most  of 


FOOD  AND  FEEDING  107 

the  coarse  parts  of  the  porridge  containing  starch  are 
strained  out.  Most  of  the  porridges  given  to  children  with 
sugar  sprinkled  over  them  are  more  likely  to  do  them  harm 
than  good. 

FRUITS 

Fruits  are  useful  as  laxatives  and,  through  the  salts  they 
contain,  as  preventives  of  scurvy.  In  case  of  the  existence 
of  that  disease,  the  juice  of  an  orange  may  be  given  (usually 
under  a  physician's  direction)  at  any  age.  But  as  a  food 
for  a  child  needing  no  treatment  it  is  permissible  very  early 
in  the  second  year,  sometimes  still  earlier.  It  hardly  need 
be  said  that  it  is  not  to  be  given  with  milk,  nor  while  milk 
is  still  probably  in  the  stomach,  so  that  it  will  need  to  be 
given  in  an  interval  between  milk  meals,  say  when  the  inter- 
val is  two  thirds  gone,  or  it  may  be  given  with  the  meat  and 
bread  meal,  as  a  dessert,  if  no  milk  is  taken.  By  the  age  of 
eighteen  months  some  cooked  fruits  are  permissible,  and  if 
constipation  exist  probably  desirable.  Those  most  generally 
procurable  of  the  suitable  sorts  are  apples  and  prunes. 
The  apples  should  be  thoroughly  baked  or  stewed,  with  as 
little  sugar  as  will  correct  an  acid  taste.  The  pulp  should 
be  carefully  strained,  or,  in  the  case  of  the  baked  apple, 
carefully  fed  to  the  child  with  a  spoon  by  the  mother  or  at- 
tendant. Prunes  must  be  very  carefully  cooked  and  sifted. 
The  writer  believes  that  in  season  the  pulp  of  thoroughly 
ripe  and  fresh  peaches  is  one  of  the  safest  forms  of  fruit. 

POTATOES 

It  will  probably  be  noticed  that  the  potato  has  not  been 
mentioned  among  the  articles  of  diet  in  the  second  year. 
This  is  because,  in  the  writer's  experience,  it  seems  better 
deferred  until  the  completion  of  dentition,  or  until  the  end 
of  the  second  year.  Many  children  are  given  potatoes  to 
eat  much  earlier,  often  before  they  are  eighteen  months  old, 
and  very  likely  some  children  can  digest  them  in  the  second 


108  THE  CENTURY  BOOK  FOR  MOTHERS 

year.  Nevertheless,  the  writer  feels  justified  in  advising 
their  postponement  until  the  end  of  this  year.  Whenever 
they  are  given,  they  must  be  baked  or  roasted  thoroughly, 
lightly  broken  up  with  a  fork,  properly  seasoned  with  salt; 
upon  them,  in  addition,  may,  if  desired,  be  put  cream  or  beef- 
juice.  Butter  upon  a  hot  potato  is  not  advisable  for  young 
stomachs  any  more  than  melted  butter  elsewhere. 

THE   FIVE   MEALS 

The  changing  of  the  kinds  of  food  has  thus  gradually  con- 
verted the  five  bottles  which  constituted  the  diet  at  the  end 
of  the  first  year  into  five  meals,  which  will  continue  for  some 
time  to  come.     These  meals  may  be  denominated  as : 

The  rising  meal,  usually 6.30  to  7  a.m. 

Breakfast  (or  the  after-bath  meal)     .    .    .  9.30  to  10  a.m. 

Dinner 12  m.  to  1  p.m. 

Afternoon  meal  or  supper 3.30  to  4  p.m. 

The  bed-meal 6.30  p.m. 

The  rising  meal  is  usually  a  bottle  of  milk  or  a  cup  of  milk 
with  bread  or  cracker.  The  bed-meal  should  be  a  small  one 
of  milk.  Breakfast  is  the  meal  at  which  the  cereal  is  intro- 
duced with  milk.  The  afternoon  supper  is  very  similar, 
but  bread  or  toast  is  more  commonly  used,  as  cereals  are 
sometimes  inconvenient  to  prepare  twice  a  day.  The  dinner 
or  midday  meal  is  that  at  which  the  meat  juices,  broths,  and 
scraped  meat  are  introduced,  as  well  as  any  of  the  admis- 
sible desserts  spoken  of. 

Of  course,  at  any  meal  where  bread  is  given  with  milk, 
the  former,  stale,  should  be  broken  into  the  milk,  but  the 
child  should  be  taught  to  chew  the  bread  and  not  swallow  the 
softened  mass  immediately  upon  putting  it  into  the  mouth. 

FEEDING  AFTER  THE   SECOND  YEAR 

With  the  opening  of  the  third  year,  if  the  child  be  a  good 
eater,  it  may  be  desirable  to  unite  the  supper  and  the  bed- 


FOOD  AND  FEEDING  109 

meal,  the  forenoon  and  midday  meal  being  made  propor- 
tionately later,  say  10 :30  to  1 :30  respectively.  If  the  child 
be  not  so  good  an  eater  or  one  of  those  who  does  not  readily 
go  to  sleep  when  put  to  bed,  the  fifth  meal,  in  the  shape  of  a 
cup  of  milk,  may  be  continued  for  a  while.  The  four-meal 
schedule  once  adopted  is  generally  continued  until  perhaps 
the  sixth  year.  Its  interruption  seems  to  be  brought  about 
not  so  much  by  any  hygienic  theories,  or  even  by  the  second 
dentition,  as  by  the  exigencies  of  school  life.  Even  then  a 
snack  at  recess  is  often  provided  for.  In  England  even 
adult  laborers,  at  least  in  some  districts,  adhere  to  a  meal 
variously  known  as  a  "tenner"  or  ''elevener,"  from  its  cus- 
tomary hour. 

GENERAL  RULES   FOR   DIET 

More  important  than  the  precise  number  or  hours  of  meals 
is  regularity  in  regard  to  the  number  and  amount.  Be- 
tween these  adopted  hours  there  should  be  no  eating.  "Be- 
tween-meal"  eating  and  ''tastes"  of  adults'  meals  should  be 
strictly  forbidden  to  children.  On  the  other  hand,  it  is  un- 
just to  take  them  to  table  with  their  elders,  who  are  eating 
savory  articles  of  food  which  they  cannot  be  allowed  to 
have.  It  is  better  that  the  child  have  its  meals  by  itself 
until  it  can  share  with  propriety  the  meals  of  its  elders 
or  can  understand  that  there  are  reasons  for  its  being 
denied. 

The  child  should  be  allowed  plenty  of  time  for  its  meals, 
but  should  not  be  allowed,  however,  to  dawdle  over  or  play 
with  them.  It  should  not  be  forced  to  eat  when  it  evidently 
does  not  desire  to  do  so.  It  should  be  taught  to  chew  its  food 
carefully,  but  should  have  food  given  to  it  which  it  can 
chew  without  fatigue.  When  the  child  has  had  enough,  let 
it  stop  eating,  rather  than  try  to  stimulate  its  appetite  by 
giving  unsuitable  dainties.  This  is  not  intended  as  a  for- 
bidding of  palatable,  well-cooked,  and  properly  seasoned 
food,  for  palatability  is  a  great  aid  to  digestion.  But  it  is 
intended  to  prevent  the  very  common  false  method  of  feed- 


110  THE  CENTURY  BOOK  FOR  MOTHERS 

ing  children,  which  results,  to  use  a  country  phrase,  in  their 
being  ''cake  hungry  but  never  bread  hungry." 

Rules  for  diet  and  hygiene  are  generally  arranged  for 
states  of  health.  When  a  child  is  ill,  the  physician  in  atten- 
dance will  specifically  dictate  the  food.  In  minor  cases  of 
illness  or  of  indisposition  the  great  rule  is  to  diminish  the 
amount  of  food  and  make  it  more  easy  of  digestion.  So  far 
as  milk  food  is  concerned,  this  is  easily  accomplished  by 
simple  dilution.  In  regard  to  other  food,  in  a  general  way 
it  may  be  said  that  solids  are  to  be  set  aside,  or,  if  used,  only 
the  more  digestible  ones. 

In  warm  weather  the  appetite  is  generally  less  than  at  other 
times  in  adults,  and  thus  the  proper  diminution  of  the  amount 
of  heat-producing  foods  is  accomplished.  Children  need  some 
oversight  in  this  regard.  Usually  the  amount  of  food  neces- 
sary is  less,  but  it  is  to  be  borne  in  mind  that  an  infant  on 
liquid  food  may  in  hot  weather  take  an  undue  amount  from 
thirst,  and  that  it  would  be  quite  as  contented  and  much 
more  comfortable  if  given  occasional  drinks  of  water  and 
less  food.  Again,  it  is  to  be  remembered  that  older  city 
children,  at  least,  are  much  more  active  in  out-door  play  in 
summer  than  in  winter,  and  for  this  reason  may  demand 
an  increased  amount  of  food  on  that  account  which  will  off- 
set the  diminution  which  should  be  made  on  account  of 
warm  weather. 

It  is  also  to  be  remembered  in  determining  the  amount 
of  food  at  any  time  that  it  is  no  question  of  how  much  a  child 
may  be  able  to  eat,  nor  in  selecting  food  should  we  ask.  Can 
the  child  eat  this  or  that  thing  Avithout  evident  injury  or 
prompt  discomfort?  But  the  question  is,  Will  this  amount 
of  this  kind  of  food  be  of  advantage  to  the  child?  And 
whenever  doubtful  indulgences  are  considered  one  must  re- 
flect whether  harm  may  come  from  them,  either  through 
remote  indigestion  or  the  causing  of  dissatisfaction  with  sim- 
pler and  more  wholesome  food.  Too  often  impulse  or  lazi- 
ness, rather  than  deliberate  thought  and  experience,  decides 
the  matter. 


FOOD  AND  FEEDING  111 

THE   THIRD   YEAR   AND   THEREAFTER 

From  the  beginning  of  the  third  year,  or  that  part  of  it  when 
the  teething  is  complete,  until  the  beginning  of  second  den- 
tition there  is  a  gradual  increase  of  the  variety,  as  well  as  in 
the  amount  of  food.  But  it  is  never  to  be  forgotten  that 
the  dietary  is  by  no  means  that  of  an  adult.  Out  of  the 
immense  variety  of  articles  of  food  and  of  methods  of  pre- 
paring them  suitable  for  the  latter,  only  a  small  part  can  be 
wisely  permitted  to  children. 

Of  the  various  groups  of  food — flesh,  fowl,  and  fish, 
with  eggs  and  milk,  vegetables  and  cereals,  fruits  and  gar- 
den produce — we  shall  point  out  below  those  which  we  con- 
sider really  desirable.  Of  those  undesirable  not  many  w^ll 
be  mentioned,  chiefly  those  which,  while  objectionable,  are 
from  some  error  often  given  to  children. 

"ANIMAL  FOODS" 

Of  milk,  so  much  has  been  said  that  no  detail  need  be 
again  gone  into.  It  usually  forms  a  considerable  part  of 
a  child's  dietary  until  the  second  dentition  begins,  and  dur- 
ing the  third  and  even  the  fourth  year  it  is  the  main  re- 
liance. From  meals  which  include  other  proteids— meat, 
eggs,  etc. — in  any  considerable  amount,  milk  is  as  well 
omitted,  or,  if  used,  it  should  be  in  less  quantity. 

Cream,  when  no  longer  added  in  milk  modification,  is  still 
very  useful.  Its  great  uses  are  as  a  laxative  article  of  food, 
and  as  a  more  digestible  form  of  unsalted  butter,  although 
it  does  still  contain  some  proteids.  Like  butter,  it  can  be 
used  to  increase  the  palatability  or  the  "richness"  of  food, 
and  of  itself  makes  a  harmless  sauce  to  many  articles  other- 
w^ise  dry. 

THE  VALUE  OF  EGGS 

Eggs  are  very  rich  in  protein  and  fats,  their  protein  value 
being  not  much  behind  that  of  an  equal  weight  of  good 
steak.     They  form  a  useful  change  in  the  third  year  and 


112        THE  CENTURY  BOOK  FOR  MOTHERS 

afterward,  but  should  be  given  only  occasionally  in  the  ear- 
lier years,  certainly  not  daily,  lest— if  for  no  other  reason— 
an  inconvenient  dislike  on  the  part  of  the  child  be  engen- 
dered. It  is  also  wise  to  have  an  interval  between  the  days 
on  which  eggs  are  given,  so  that  if  any  idiosyncrasy  regard- 
ing them  exists  it  may  be  the  more  readily  detected.  It  is 
probably  these  occasional  personal  peculiarities  which  have 
given  rise  to  the  popular  dictum  that  "eggs  are  bilious.*' 
They  should  be  given  only  soft-boiled  or  poached— i.  e., 
dropped  into  boiling  water— and  for  these  purposes  only  the 
very  freshest  eggs  are  suitable.  If  really  fresh  eggs  cannot 
be  obtained,  the  child  will  be  better  without  them. 

VARIOUS  MEATS 

Of  the  great  variety  of  meat  foods,  very  few  are  suitable 
for  children.  All  salted  or  smoked  meats,  all  game,  all 
preparations  of  meat— such  as  sausage— intended  to  be  eaten 
uncooked  are  at  once  set  aside.  The  choice  as  to  ''butchers'  " 
meat  is  practically  only  between  beef  and  mutton.  Veal  is 
quite  unsuitable,  and  lamb,  unless  we  use  the  word  as  a  com- 
plimentary name  for  young  mutton,  is  not  nearly  so  digest- 
ible as  the  mature  meats.  The  writer  believes  that  this  is 
true  of  all  flesh  of  immature  animals.  Pork  is  the  most  in- 
digestible of  all  meats  usually  sold.  Bacon,  it  is  true,  is  far 
more  digestible  than  other  pork  food,  but  this  advantage  is 
generally  more  than  destroyed  by  cooking  the  meat  to  crisp- 
ness,  in  which  state  few  young  children  can  digest  it. 

Beef,  then,  in  the  form  of  steak  or  roast  beef,  and  mutton 
roasted,  boiled,  or  as  a  chop,  constitute  the  child's  variety  of 
meat.  Mutton  is  the  more  digestible  of  the  two,  but  for 
some  reason  this  fact  seems  to  be  less  well  known  in  this 
country  than  formerly.  The  meat  should  be  cooked  to  the 
condition  known  as  rare— that  is  to  say,  cooked  beyond  the 
blue  stage,  so  that  its  juices  run  freely  as  it  is  cut,  but  still 
red,  and  not  brown,  in  the  interior. 

Of  poultry,  only  the  fowl  and  the  turkey  are  permissible, 


FOOD  AND  FEEDING  113 

and  in  the  earlier  years  only  the  white  meat  of  the  bird. 
Young  birds  are  more  tender  than  old  ones,  but  they  should 
be  fully  grown.  They  should  be  thoroughly  cooked.  The 
flesh  of  ducks  and  geese  have  no  place  in  the  nursery. 

The  same  may,  as  a  rule,  be  said  of  parts  of  animals  used 
as  food  for  adults,  such  as  liver,  kidneys,  and  the  like.  Both 
tripe  and  sweetbreads  are  digestible,  but  as  usually  cooked 
their  digestibility  is  destroyed,  and  in  any  case  their  use  in 
the  nursery  should  be  forbidden,  unless  they  are  thoroughly 
and  simply  stewed  and  served  ^vithout  sauces,  in  which  case 
they  are  often  insipid. 

Made  dishes  and  hashes  must  likewise  be  disapproved  of, 
because  they  are,  as  a  rule,  made  of  the  less  desirable  parts 
of  meat  previously  cooked  and  served.  They  are  also  usu- 
ally overseasoned  and  overdone.  A  fine  mince  made  from 
previously  uncooked  meat  or  carefully  made  from  good  parts 
of  a  roast  and  not  unduly  seasoned  or  sauced  may  sometimes 
be  given  in  an  emergency. 

It  seems  hardly  necessary  to  call  attention  to  the  fact  that 
nothing  intended  for  nursery  food  is  to  be  fried.  Even 
skilful  frying  in  the  fat  kettle  is  undesirable,  and  too  many 
American  cooks  have  too  far  forgotten  this  art  to  make  it 
safe  to  admit  frying  at  all. 


FISH  AS   FOOD 

Fish  for  young  children  should  be  only  of  a  few  digestible 
kinds,  and  should  be  particularly  fresh  and  sweet,  even  more 
so  than  if  for  the  use  of  adults.  This  requirement  of  fresh- 
ness restricts  the  use  of  fish  considerably,  since  in  the  winter 
in  many  places  fish  can  be  had  only  after  it  has  been  kept  a 
long  time  on  ice.  Fish  which  are  very  fat  are  not  very 
digestible,  hence  the  tribe  of  mackerels,  including  the  blue- 
fish,  and  some  of  the  herrings  are  pretty  strong  for  a  child 's 
stomach.  The  same  is  true  of  the  eel,  as  well  as  of  the  salmon. 
The  cod,  w^hen  young  and  in  season,  the  haddock,  the  hali- 
but, the  striped  bass,  have  all  white  flesh  which  is  nutri- 


114  THE  CENTURY  BOOK  FOR  MOTHERS 

tious  and  digestible,  and  the  fish  is  large  enough  to  give  good 
pieces  for  boiling  or  broiling,  the  only  ways  in  which  fish 
should  be  prepared  for  children.  The  flesh  of  the  large 
flounder,  sometimes  called  plaice,  is  good  boiled,  but  rather 
dry ;  that  of  the  squeteague,  or  weakfish,  is  good  broiled,  but 
too  soft  for  boiling.  It  is  a  fish  which  preeminently  needs 
to  be  used  very  fresh  to  preserve  its  flavor.  The  black  sea- 
bass  of  Northern  markets  and  the  tautog  (called  blackfish 
in  New  York)  are  both  good  fish.  Southern  markets  have 
many  excellent  fish,  but  they  are  not  so  good  for  children's 
use  if  transported.  Of  fresh-water  fish,  few  are  market- 
able far  from  the  place  of  their  capture  in  a  condition  suit- 
able for  the  nursery  table.  The  best,  when  fresh,  are  the 
trout,  the  whitefish,  the  yellow  perch,  and  young  pickerel. 
Black  bass  from  clean  waters,  the  white  perch,  and  perhaps 
the  pike  perch  may  be  admitted.  The  objection  to  most  of 
these  fish  is  their  size,  which  makes  them  too  small  for  boil- 
ing and  often  for  broiling.  They  are  therefore  usually  fried, 
which,  as  has  been  said,  is  not  a  good  method  of  cooking  for 
young  children. 

Salt  fish  and  smoked  fish  need  only  be  mentioned  as  unde- 
sirable.    They  are  too  difficult  of  digestion. 

Boiled  or  broiled  fish  must  not  be  served  with  fat  sauces. 
Broiled  fish  must  not  be  buttered  in  broiling.  A  little  salt 
put  upon  them  some  time  before  the  broiling  improves  the 
flavor.  For  boiled  fi^sh  no  sauce,  or  the  simplest  cream  sauce 
only,  can  be  allowed. 

Shell-fish  need  but  a  word.  Except  the  oyster,  none  are 
fit  for  the  nursery,  and  even  this  excepted  one  is  rather  an 
indulgence  than  a  desirable  food  for  children.  It  can  be 
given  only  stewed.  It  makes,  however,  one  of  the  many 
broths  which  are  now  permitted.  Oysters  give  an  agreeable 
flavor  to  the  milk  and  other  ingredients  in  which  they 
are  cooked,  even  if  the  oyster  itself  be  not  eaten.  Clams 
may  be  used  in  the  same  way,  but  the  broth  must  be  strained 
to  get  rid  of  the  clams  themselves,  which  are  quite  unsuitable 
for  children's  food.     These  broths  are  very  appetizing,  but 


FOOD  AND  FEEDING  115 

their  nutritive  value  is  largely  in  the  milk  added,  as  well 
as  in  the  cracker  or  flour  thickening,  if  any  be  used. 

SOUPS 

Broths  or  soups  of  various  sorts,  besides  those  before  de- 
scribed, may  be  allowed  to  children,  but  they  should  be  plain. 
Most  soups  into  which  vegetables  enter  require  to  be  strained, 
so  that  the  latter  may  give  flavor  without  the  more  or  less  in- 
digestible substances.  The  potato  soup,  if  well  made,  is  an 
exception,  the  vegetable  making  an  excellent  puree.  Soups 
of  meat  can  be  made  more  nutritious,  as  well  as  varied,  by 
the  addition  of  rice,  barley,  or  vermicelli  or  Italian  paste. 
In  making  soups  for  the  nursery  it  is  to  be  borne  in  mind 
that  they  must  be  as  nutritious  as  practicable,  but  digestible 
certainly.  No  so-called  rich  soups  are  permitted,  because 
nearly  always  the  "richness"  is  due  not  to  nutrients  so  much 
as  to  indigestible  additions. 

VEGETABLES 

The  potato  has  already  been  mentioned  as  the  fii^t  vege- 
table allowed  to  children.  It  continues  through  childhood, 
and  through  life  in  fact,  the  most  generally  useful  of  vege- 
tables. During  the  whole  of  the  period  which  is  under  con- 
sideration—i.  e.,  until  the  beginning  of  second  dentition— it 
should  still  be  given  baked.  Boiled,  it  is  as  a  rule  less  light 
or  ''mealy."  Stewed,  it  is  of  doubtful  propriety,  and  fried 
or  sauted,  it  is  distinctly  objectionable.  Siveet  potatoes  are 
less  desirable,  as  a  really  mealy  one  is  not  very  common,  even 
the  best  having  an  adhesiveness  far  beyond  that  of  the  best 
white  potatoes.  If  given  at  all,  they  should  be  baked  and 
given  only  to  children  over  five. 

This  objection  of  toughness  and  indigestibility  is  still  more 
pronounced  against  the  immature  white  potatoes  sold  as 
''new  potatoes."  However  palatable  they  may  be,  they 
must  be  denied  to  young  children.     This,  however,  does  not 


116  THE  CENTURY  BOOK  FOR  MOTHERS 

apply  to  the  fresh  crop  of  mature  potatoes.  The  white 
potato  has  the  advantage  of  being  available  throughout  the 
year. 

During  the  season  of  fresh  vegetables  there  are  a  number 
which  are  wholesome  even  during  the  third  and  fourth  year. 
The  choice  of  winter  vegetables  is  more  restricted. 

Two  or  three  things  may  as  well  be  first  mentioned.  First, 
a  young  child  should  eat  no  uncooked  vegetables.  All  vege- 
tables should  be  thoroughly  cleansed  before  cooking,  all  im- 
perfect parts  being  discarded.  Most  vegetables,  if  boiled, 
lose  less  of  their  value  and  flavor  if  the  water  be  slightly 
salted.  Lastly,  and  perhaps  most  important,  all  green  vege- 
tables must  be  eaten  while  quite  fresh,  or  their  advantages 
as  articles  of  food  are  doubtful.  The  effect  of  each  article 
upon  digestion  should  be  watched.  Among  the  tenderest  and 
most  digestible  of  the  summer  vegetables  are  asparagus,  peas, 
and  string-beans. 

Asparagus-tops  cooked  very  tender,  served  without  sauce 
or  with  cream  only,  are  usually  digestible  in  the  third  year. 
The  odor  communicated  to  the  urine  by  the  vegetable  is  dis- 
agreeable, and  sometimes  causes  alarm  to  those  mothers  who 
had  not  previously  noticed  it. 

Peas  should  be  given  only  when  especially  tender.  No 
amount  of  cooking  can  make  an  old  tough  pea  soft.  In  fact, 
it  is  claimed  that  they  grow  harder  in  boiling,  and  they  can 
hardly  be  less  refractory  to  digestion. 

String-beans  must  be  equally  tender  and  be  well  cooked 
and  well  chewed. 

Some  varieties  of  beans  eaten  without  the  pods  may  be 
given  if  tender  and  thoroughly  cooked.  But  it  is  to 
be  noticed  that  they  vary,  and  even  different  messes  from 
the  same  source  vary  very  greatly  as  to  tenderness,  and 
unless  the  mother  can  make  a  daily  test  of  this  they  are 
better  not  given.  Tough  beans  are  among  the  most  indi- 
gestible of  fresh  vegetables.  Dried  beans  in  the  form  of 
baked  beans,  while  a  very  nutritious  form  of  food,  are  not 
within  the  digestive  abilities  of  most  children  of  the  age  of 


FOOD  AND  FEEDING  117 

six  or  Tinder.  But  in  the  fifth  or  sixth  year  a  well-made 
bean  or  pea-soup  may  agree.  Peas  and  beans  contain  such 
a  large  amount  of  proteids  as  to  quite  equal,  pound  for 
pound,  the  best  lean  beef,  besides  m^uch  starch.  When  the 
fat  of  pork  is  added  it  is  evident  why  the  combination  is  of 
such  high  repute  as  a  food.  Nevertheless,  children,  as  well  as 
adults  of  feeble  digestion,  would  better  not  try  such  heavy 
food. 

Of  the  vegetables  which  can  be  had  in  good  condition 
later  in  the  year  we  may  mention  the  onion,  cauliflower, 
and  spinach. 

The  best  onions  are  called  Spanish  or  Bermuda,  their  flavor 
being  less  harsh  than  others.  For  the  nursery  they  are  to 
be  boiled  or  baked,  the  former  being,  in  the  writer's  judg- 
ment, preferable.  They  must  be  cooked  until  thoroughly 
tender.  They  are  acceptable  without  sauce,  but  if  sauce  be 
desired  it  should  be  of  cream,  not  melted  butter. 

Cauliflower  is  the  only  plant  of  the  cabbage  family  which 
should  be  allowed  to  young  children.  It  should  be  boiled 
and  served  in  the  same  manner  as  directed  for  onions,  but 
it  is  not  an  easy  vegetable  to  prepare  properly  for  the 
nursery. 

Spinach,  in  the  form  of  a  puree,  is  one  of  the  stand-bys  of 
the  nursery  table  in  winter.  What  has  been  said  about 
cleansing  and  boiling  of  vegetables  applies  emphatically  to 
spinach.  For  children  it  must  be  put  through  a  sieve  or  a 
fine  colander.  It  should  not  be  given  in  the  rustic  form  of 
''greens."  Like  the  onion  and  perhaps  the  cauliflower,  it 
is  accounted  slightly  laxative,  but  it  cannot  be  charged,  as 
they  sometimes  are,  with  causing  gas.  It  is  said  to  contain 
an  appreciable  amount  of  iron,  which  makes  it  valuable  in 
the  dietary  of  winter  and  spring. 

The  quantity  of  all  these  vegetables  must  at  first  be  small, 
a  single  onion,  a  dessertspoonful  of  cauliflower  or  of  spinach, 
for  instance,  and  gradually  increased  if  found  to  agree. 

Celery,  carefully  prepared  by  boiling  or  prolonged  stew- 
ing until  thoroughly  tender,  is  an  acceptable  vegetable,  but 


118  THE  CENTURY  BOOK  FOR  MOTHERS 

its  nutritive  value  is  not  great.  Of  the  vegetables  known  in 
common  speech  as  "roots"— turnips,  beets,  carrots,  parsnips, 
etc. — few  are  tender  or  digestible  enough  for  young  children. 

The  heet,  if  it  could  be  gotten  tender  and  thoroughly 
cooked,  might  be  useful,  but  in  practice  the  writer  has  rarely 
found  it  properly  prepared,  and  has  been  obliged  to  conclude 
that  the  toughness  of  the  vegetable  is  not  properly  appre- 
ciated in  the  kitchen. 

The  carrot,  to  be  allowable,  must  be  very  thoroughly  cooked 
and  put  through  a  sieve,  and  it  is  doubtful  if  its  accepta- 
bility to  the  childish  palate  and  its  nutritive  value  are  suffi- 
cient to  repay  the  trouble.  The  vegetable  is  mentioned  only 
as  a  resource  for  occasions  when  something  Avith  salts  in  its 
composition  is  needed  and  nothing  better  is  at  hand. 

The  question  is  sometimes  asked.  Are  canned  vegetables 
proper  for  use  in  winter?  The  answer  depends  upon  the 
quality  of  the  vegetable.  Some  kinds  of  vegetables  preserve 
their  original  qualities  well,  some  do  not,  and  of  the  for- 
mer the  wares  of  one  factory  may  be  good  and  tender,  those 
of  another  stale  and  tough.  In  many  places  the  alternative 
is  to  use  canned  goods  in  the  winter  or  to  go  without  green 
vegetables  altogether.  In  other  places  the  best  canned  vege- 
tables seem  to  be  really  better  than  those  brought  from  a  long 
distance  in  cold  storage.  No  fixed  rule,  therefore,  can  be 
made.  Each  article  must  be  judged  by  itself.  There  are,  for 
instance,  canned  peas  in  the  market  as  tender  and  nearly  as 
palatable  as  those  freshly  picked ;  there  are  others  which  are 
burdensome  even  to  an  adult  stomach.  In  every  case  of 
doubt  err  upon  the  safe  side,  and  refuse  to  give  the  vege- 
tables to  the  child. 

BREAD   AND    CEREALS 

The  directions  given  for  their  use  in  the  second  year  are 
still  valid.  No  fresh  breads  should  come  into  the  nursery. 
Bread  should  be  at  least  a  day  old,  and  the  whole  list  of 
biscuits,  muffins,  etc.,  are  tabooed.     All  the  ordinary  cereal 


FOOD  AND  FEEDING  119 

preparations,  if  well  cooked,  are  permissible  and  for  the 
most  part  desirable.  Oatmeal  is  a  standard.  Wheaten 
preparations,  of  numberless  trade  names,  preferably  those 
not  of  the  coarsest  sort,  are  excellent,  especially  as  a  change 
from  the  oatmeal  or  when  the  latter  seems  to  be  the  cause 
of  skin  irritation,  as  it  occasionally  does.  There  is  also  a 
long  range  of  preparations  of  Indian  corn,  such  as  Indian 
meal,  farina,  hominy,  and,  for  those  children  old  enough  to 
chew  well,  samp  and  hulled  corn,  meaning  that  hulled  by 
machinery;  that  hulled  by  the  use  of  alkalis  can  be  given 
only  if  very  carefully  washed  free  from  the  alkali.  Rice  is 
also  useful.  Tapioca  and  sago  used  in  the  adult  dietary 
are  not  so  desirable  for  children  as  ordinarily  prepared. 
Their  place  is  really  as  a  component  of  nursery  desserts, 
which  should  be  so  delicately  made  that  the  tenacity  of  these 
ingredients  may  be  overcome. 


MACARONI 

Macaroni  may  be  mentioned  in  connection  with  the  cereals. 
Being  made  from  a  peculiar  Italian  wheat,  the  real  maca- 
roni is  rich  in  gluten,  and,  while  very  nutritious,  is  some- 
times tough  and  resistent  to  digestion.  For  nursery  use, 
therefore,  the  finer  kinds,  vermicelli  and  spaghetti,  are  pref- 
erable. It  is  quite  possible  by  careless  cooking  to  render 
the  macaroni  a  disagreeable,  pasty  mass.  This  is  best  pre- 
vented by  keeping  the  water  boiling  while  the  broken  pieces 
are  dropped  in,  a  few  at  a  time,  so  that  the  heat  shall  not 
be  noticeably  checked.  For  nursery  use  it  must  not  be 
served  with  cheese,  tomato,  or  other  relishes,  but  plain,  with 
milk  or  cream. 

DESSERTS 

It  is  left  to  speak  of  such  things  as  constitute  suitable  nur- 
sery desserts.  They  are  not  very  many,  and  must  be  all 
rather  simple.  Perhaps  the  commonest  is  junket,  otherwise 
known  as  rennet  custard  or  slip.     It  is,  of  course,  merely  an- 


120       THE  CENTURY  BOOK  FOR  MOTHERS 

other,  and  usually  an  attractive,  way  of  giving  milk.  This 
should  be  borne  in  mind  if  the  meal  has  contained  already 
milk  or  much  proteids  of  any  sort.  Similar  desserts  are 
custards,  baked  or  boiled.  They  are  equally  rich  in  proteids, 
to  some  persons  less  digestible  because  of  the  egg  used,  and 
are  therefore  not  to  be  used  so  early  as  junket,  but  are  usu- 
ally well  borne,  in  moderate  amount,  at  two  and  one  half 
or  three  years. 

Rice  puddings  and  bread  puddings  may  be  given  by  the 
latter  date  if  made  simply.  Very  good  rice  puddings  can  be 
made  without  eggs,  and,  however  made  in  other  respects, 
should  be  free  from  the  too  common  fault  of  excessive  sweet- 
ness. Rice  pudding  is  usually  quite  as  agreeable  cold  as 
hot,  but  the  same  is  not  true  of  bread  puddings.  The  ob- 
jection to  ice-cream  is  less  its  composition  than  its  tempera- 
ture. It  is  not  helpful  to  digestion  to  take  any  considerable 
amount  of  very  cold  substance  into  the  stomach  as  a  part  of 
a  meal.  In  the  third  year  only  perhaps  a  dessertspoonful  is 
to  be  allowed,  and  that  should  be  partially  softened  before 
giving  it.     Only  simple  ice-creams  should  be  used. 

No  pastries  of  any  sort  should  be  given,  and  if  any  cake 
only  sponge  cake  or  simple  gingerbread.  Many  desserts,  how- 
ever, can  be  made  from  fruit,  either  in  its  natural  state  or 
cooked.  The  early  use  of  oranges  and  of  stewed  prunes  has 
already  been  spoken  of.  Both,  especially  the  orange,  remain 
for  a  long  time  acceptable  to  the  childish  palate.  Apples  are 
not  very  digestible  uncooked,  but  the  baked  apple  is  much 
more  so.  They  are  best  given  baked,  either  alone  or  with 
cream.  There  are  many  very  tasty  dishes  made  from  apples, 
such  as  "Brown  Betty,"  and  rich  mixtures  with  jelly  and 
cream,  which  are  not,  in  the  writer's  belief,  very  digestible. 
As  a  variant,  stewed  apple-sauce  is  good.  But  it  is  to  be  noted 
that  for  either  baking  or  stewing  good  sweet  apples  should 
be  chosen,  else  the  amount  of  sugar  needed  to  make  them 
palatable  is  more  than  is  well  borne  by  the  digestion.  In 
the  third  year  the  pulp  of  sweet  apples  may  be  given  un- 
cooked if  it  be  scraped  up  finely  with  a  spoon.     Pears  are 


FOOD  AND  FEEDING  121 

akin  to  apples.  A  very  good  pear  is  often  accounted  more 
digestible  than  an  apple.  The  coarser  varieties  of  pears  can 
only  be  eaten  cooked.  The  chief  objection  to  the  pulp  of 
a  fine  pear  is  that  in  a  good  many  stomachs  it  seems  to  excite 
acidity,  and  is  therefore  (for  such  persons  at  least)  not 
desirable  at  a  time  when  the  dietary  contains  much  milk. 


FRUIT 

Most  berries  are  scarcely  worth  considering  in  the  early 
years ;  they  disturb  the  bowels  more  frequently  than  is  com- 
pensated for  by  their  little  food  value.  The  strawberry  in 
a  perfectly  sound  and  ripe  condition  may  be  tried  cautiously, 
however,  in  the  third  or  fourth  year,  cautiously  because 
there  exist  more  idiosyncrasies  in  regard  to  this  fruit  than 
probably  in  regard  to  any  other. 

One  of  the  most  persistent  of  winter  fruits  is  the  banana. 
Quite  a  little  popular  controversy  has  arisen  as  to  its  digesti- 
bility. The  question  cannot  really  be  discussed  in  the  North- 
ern States,  to  which  the  fruit  comes  in  an  unripe  state  to 
be  ripened.  It  is  also  usually  bought  for  use  imperfectly 
ripened.  So  that  w^hatever  be  the  truth  about  the  banana 
where  it  grows,  as  bought  in  the  North  it  is  not  suitable  for 
children  under  seven  years.  But,  cooked,  the  writer  has 
found  it  wholesome  and  generally  liked  by  children.  Ba- 
nanas are  as  easily  baked  in  their  skins  as  are  apples.  The 
skins  turn  black  in  the  cooking.  They  are  easily  removed, 
leaving  a  soft  pulp  rather  less  firm  than  that  of  a  baked 
apple,  which  is  very  palatable  without  any  addition,  but 
cream  may  be  used  if  desired. 

Grapes  come  rather  early  into  use,  but  for  little  children 
the  seeds  and  skins  must  be  removed,  so  that  the  solid  pulped 
grapes,  of  which  the  white  Malaga  grape  is  the  type,  are 
practically  the  only  ones  which  can  be  used. 

Melons  belong  to  the  doubtful  articles,  because  so  many 
melons  are  poor.  The  pulp  of  a  really  good  melon,  whether 
watermelon  or  canteloupe,  is  very  tender  and,  we  believe,  di- 


122       THE  CENTURY  BOOK  FOR  MOTHERS 

gestible.  Owing  to  the  uncertainty  of  the  melon's  character 
until  it  is  cut  it  cannot  be  ordered  for  the  nursery.  It  can  be 
given  only  when  one  of  the  proper  quality  actually  appears. 

The  peach  has  already  been  spoken  of. 

Of  dried  fruits,  dates  and  figs  are  sometimes  given.  They 
are  of  doubtful  propriety  unless  they  are  cooked,  as  their 
flesh  is  too  tenacious  for  children  of  an  age  at  which  they 
rarely  chew  anything  very  well. 

Nuts  can  be  only  mentioned  to  be  forbidden. 

The  list  of  foods  above  given  has  been  made  as  long  and 
as  inclusive  as  the  writer  felt  proper.  Articles  not  men- 
tioned are  to  be  understood  as,  in  his  opinion,  undesirable  or 
objectionable. 

WATER  AND  OTHER   DRINKS 

Of  drinks  none  are  proper  but  water.  If  the  water-supply 
be  of  doubtful  purity  the  water  may  be  filtered,  if  a  really 
good  filter  is  at  hand.  If  not,  it  may  be  strained  through  cot- 
ton or  flannel  and  boiled  and  set  aside  to  cool  before  using. 
Aerated  waters  may  be  given  in  small  quantities  only.  Milk 
should  be  always  thought  of  as  food,  although  its  compo- 
nent water  makes  it  a  quencher  of  thirst.  Water  should 
be  very  early  offered  to  children  in  small  quantities,  as  their 
thirst  is  very  often  mistaken  for  hunger.  Tea  and  coffee 
are  never  to  be  allowed,  and  wine  or  beer  only  under  a  physi- 
cian's  specific  direction.  As  an  occasional  article  of  diet 
light  cocoa  beverages  may  be  used  in  the  later  years  of  the 
period  under  discussion.     But  even  these  are  better  omitted. 

OBJECTIONS  TO   SWEETS 

The  writer  believes  that  in  the  foregoing  list  of  articles  of 
food  for  young  children  he  has  included  all  that  are  admis- 
sible. All  others  being  considered  as  usually  inadmissible, 
no  list  of  excluded  articles  is  made.  It  is,  however,  perhaps 
necessary  to  make  especial  mention  of  candy  and  sweets  as  ob- 


FOOD  AND  FEEDING  123 

jeetionable.  So  long  as  a  child's  diet  is  largely  made  up  of 
milk  food  it  gets  an  ample  amount  of  sugar.  Later  it  gets 
in  its  cereals,  bread,  and  potato  much  starch  which  is  con- 
verted by  digestion  into  sugar.  All  through  life  in  most 
civilized  countries,  certainly  in  our  own,  food  is  generally 
sweetened  beyond  the  needs,  and  very  frequently  beyond  the 
toleration  of  the  average  system. 


IX 


DISORDERS  ASSOCIATED  WITH 
IMPROPER  FEEDING 

IN  connection  with  the  subject  of  feeding  it  is  proper  to 
mention  some   disorders  associated  with  or  dependent 
upon  improper  diet.     First  may  be  mentioned  rickets. 

SYMPTOMS  OF  RICKETS 

This  disease,  called  scientifically  rachitis,  is  a  general  one 
affecting  all  parts  of  the  system,  but  being  most  striking  in 
its  effects  upon  the  bones  of  the  body,  which,  through  an 
arrest  in  the  ossifying  process,  become  soft  and  often  dis- 
torted. It  is  a  disease  which  in  well-cared-for  children 
rarely  reaches  a  pronounced  degree.  The  striking  bony 
changes  spoken  of  are  usually  seen  among  the  poor,  and  in 
this  country  most  of  the  cases  are  found  in  the  children  of  the 
negroes  and  Italian  immigrants.  The  milder  cases  of  rickets 
are  often  seen  among  the  well-to-do,  but,  the  early  symptoms 
being  recognized,  are  corrected  before  deformity  has  resulted. 

Rickets  usually  occurs  within  the  first  two  years  of  life, 
and  especially  after  weaning  or  the  failing  of  an  adequate 
breast-supply ;  both  too  early  and  too  late  weaning  may  lead 
to  improper  or  insufficient  feeding. 

The  most  noticeable  symptoms  are  the  following:  The 
earliest  manifestation  is  often  overfatness,  with  constipa- 
tion. Sometimes  diarrhoea  is  present,  or  alternates  with  the 
constipation.  The  child  perspires  more  than  is  natural,  es- 
pecially about  the  head  and  neck.     Teething  is  backward. 

124 


DISORDERS  ASSOCIATED  WITH  IMPROPER  FEEDING  125 

It  should  be  said,  however,  that  this  symptom  is  not  alone 
conclusive  of  rickets— if,  indeed,  any  one  of  the  symptoms 
above  given  alone  be— since  family  peculiarity  has  much  to 
do  with  the  time  of  the  eruption  of  the  teeth. 


CHANGES   DUE  TO   RICKETS 

If  the  disease  advances  far  enough  to  produce  bony  changes 
the  most  common  are  the  following :  The  head  is  prominent  in 
places,  especially  in  the  frontal  and  parietal  bones,  making 
the  naturally  rounded  contours  of  the  baby's  head  rather 
more  angular  or  square,  as  is  usually  said.  The  face  some- 
what shares  in  this  angularity.  Often  the  skull-bones,  on 
handling,  are  felt  to  be  softer  and  thinner  in  places  than 
they  should  be.  This  is  usually  most  marked  at  the  back 
of  the  head.  The  chest,  owdng  to  the  yielding  of  the  ribs, 
takes  the  shape  known  as  pigeon-breast  or  keel-breast— that 
is  to  say,  there  are  depressions  at  the  sides  not  far  from  the 
line  of  the  nipples,  while  the  breast -bone  and  the  middle  of 
the  chest  project  like  a  keel.  This  change  of  shape  dimin- 
ishes the  capacity  of  the  chest,  and  renders  more  important 
any  bronchitis  or  other  lung  trouble  which  may  occur,  and 
a  tendency  to  which  may  be  favored  by  the  rachitic  condi- 
tion. Sometimes  the  points  where  the  ribs  join  their  car- 
tilages are  increased  in  size,  and  those  rows  of  knobs  have 
gained  the  name  of  "the  rickety  rosary."  The  long  bones, 
when  affected,  bend,  making,  according  to  the  parts  subjected 
to  the  pressure  of  the  weight  of  the  body,  various  distortions, 
among  which  knock-knee,  bow-legs,  and  curved  shins  are  the 
most  familiar. 

CAUSES  AND  CURE  OF  RICKETS 

The  cause  of  rickets  is  undoubtedly  due  to  defective  feed- 
ing, or  feeding  inappropriate  to  the  digestive  powers  of  the 
child.  The  exact  form  of  unsuitableness  may  vary  greatly, 
but  actually  the  errors  by  far  most  frequently  recognized 


126  THE  CENTURY  BOOK  FOR  MOTHERS 

are  an  absence  or  deficiency  of  fat  in  the  food  and  the  giving 
of  starchy  food  when  it  cannot  be  digested  or  in  greater 
amount  than  can  be  digested.  It  therefore  is  likely  to  occur 
in  infants  who  are  given  the  food  of  adults  and  in  those  fed 
upon  so-called  infant  foods,  which  are  very  starchy  and 
deficient  in  fat. 

The  disease  usually  develops  rather  gradually,  and  is  re- 
covered from  with  proportionate  slowness.  Its  cure  consists 
essentially  in  removing  its  cause— that  is  to  say,  in  correct- 
ing the  errors  in  diet,  as  well  as  in  hygiene,  if  any  exist. 
Medicinal  treatment  wisely  directed  may  also  assist  the  cure. 

INFANTILE  SCURVY 

Another  disease,  once  called  acute  rickets  from  an  erro- 
neous idea  of  its  nature,  arising  from  dietetic  error  is  scurvy. 
It  is  also,  for  distinction  from  ordinary  scurvy,  called  in- 
fantile scurvy  or  scurvy-rickets. 

The  symptoms  likely  to  attract  the  attention  of  the 
mother  are  these :  The  child  is  restless,  or  may  be  peevish, 
but  it  will  generally  be  found  that  it  is  relatively  contented 
if  left  alone,  but  cries  if  touched.  It  has  diminished  appe- 
tite, looks  pale,  and  may  sometimes  have  disordered  bowels. 

The  condition  of  the  blood  is  changed,  and,  as  in  ordinary 
scurvy,  may  escape  from  the  blood-vessels  in  almost  any 
part  of  the  body.  The  commonest  situations  are  in  the 
gums,  which  are  in  that  case  tender  and  bleeding,  but  this 
symptom  is  not  likely  to  occur  before  the  teeth  begin  to  come. 
"Black-and-blue  spots"  appear  on  the  skin,  sometimes  giv- 
ing the  appearance  of  a  black  eye,  or,  if  the  bleeding  be  into 
the  loose  tissue  of  the  orbit,  the  eye  may  protrude  somewhat. 
A  very  striking  characteristic  is  the  swelling  of  the  limbs, 
especially  the  lower,  due  to  bleeding  beneath  the  periosteal 
covering  of  the  bone.  The  swelling  is  spindle-shaped  or 
pear-shaped  and  very  tender  to  touch.  More  rarely  blood 
escapes  from  the  bowels  or  with  the  urine.  Occasionally,  in 
connection  with  the  periosteal  bleeding  in  the  lower  limbs, 


DISORDERS  ASSOCIATED  WITH  IMPROPER  FEEDING  127 

the  bones  may  be  fractured.  But  the  changes  already  de- 
scribed as  due  to  rickets  are  not  marked  unless  the  child  be 
also  afflicted  with  that  disease. 

CAUSES  AND  CURE  OF  SCURVY 

This  disease,  unlike  rickets,  may  occur  in  children  more 
carefully  looked  after,  although  not  confined  to  them.  The 
essential  dietetic  error  seems  to  be  a  lack  of  freshness  in 
the  food— that  is  to  say,  it  rarely  occurs  if  the  infant  gets 
fresh  milk  as  food,  but  much  more  frequently  if  the  diet 
is  of  condensed  milk  or  dry  prepared  foods.  It  sometimes 
occurs  when  fresh  milk  is  the  food  if  the  milk  is  sterilized 
too  long  or  at  too  high  a  temperature.  The  use  of  fresh 
food  in  the  form  of  meat-juice,  for  those  infants  old  enough 
to  take  it,  seems  to  be  useful  both  as  preventive  and  curative. 
The  high  value  of  fresh  vegetables  for  both  these  pur- 
poses is  well  knoAvn  as  regards  the  scurvy  of  adults,  and  the 
same  is  found  true  in  infancy.  But  the  available  kinds  are 
few,  since  the  disease  usually  occurs  between  six  and  eight- 
een months.  Most  frequently  used,  both  because  it  is  palat- 
able and  easily  borne,  is  orange  juice.  The  giving  of  the 
juice  of  a  half  or  a  Avhole  orange  of  good  size,  according  to 
the  age  of  the  child,  once  a  day  is  generally  followed  by 
prompt  improvement  of  the  symptoms  and  by  cure.  The 
juice  of  grapes  and  the  pulp  of  apples  have  also  been  given. 
In  cases  where  fruit  juices  for  any  reason  cannot  be  had,  it 
has  been  found  that  fresh  vegetables,  such  as  carrots  or 
potatoes,  cooked  in  beef  soup,  impart  an  anti-scorbutic  value 
to  the  soup,  although  the  vegetables  are  carefully  strained 
out.  A  very  thoroughly  cooked  potato,  beaten  up  into  a 
cream  with  milk,  may  also  be  given  to  advantage ;  at  first  a 
teaspoonful  and  later  a  larger  quantity  being  added  to  each 
bottle  of  food. 

HABITUAL  CONSTIPATION 

Constipation  is  of  many  kinds,  and  may  depend  upon  a 
very  great  variety  of  causes.     But  in  popular  language  the 


128       THE  CENTURY  BOOK  FOR  MOTHERS 

word  is  generally  used  to  signify  hahitual  constipation,  and 
since  in  infancy  this  condition  commonly  depends  upon 
dietetic  or  hygienic  errors  it  is  proper  to  consider  it  in  con- 
nection with  those  diseases  due  to  faulty  food  or  feeding. 
If  the  child  is  suckled  the  constipation  may  depend,  or  at 
least  seem  to  depend,  upon  constipation  in  the  mother,  or  it 
may  be  due  to  a  faulty  composition  of  the  breast  milk.  If 
the  child  be  bottle-fed  the  usual  faults  of  composition  in 
the  food  are  too  little  fat,  with  or  wdthout  an  excess  of 
casein.  The  value  of  the  fat  as  a  laxative  has  already  been 
alluded  to.  It  will  be  remembered  that  in  typical  breast 
.milk  the  percentage  of  fat  was  put  down  as  three  or  four 
'times  that  of  the  proteids.  It  will  also  be  remembered  that 
at  first  the  percentages  in  the  artificial  food  mixtures  rec- 
ommended were  kept  below  those  of  the  standard  breast  milk. 
It  does  seem,  however,  that  if  their  relative  proportion  be 
not  much  disturbed  the  bowels  keep  in  pretty  good  condi- 
tion while  the  actual  percentages  are  still  low.  As  in  later 
infancy  higher  proteid  percentages  are  reached,  and  the 
proteid  is  chiefly  casein,  it  is  sometimes  not  practicable  to 
proportionately  run  up  the  fat  percentages.  The  digestion 
rebels  against  such  an  amount  of  fat.  Nevertheless,  the 
best  results  are  reached  through  the  increase  of  the  fat 
percentage  in  the  food  toward,  but  short  of,  the  limit  of  tol- 
erance. It  will,  of  course,  be  at  once  seen  why  constipation 
so  often  follows  the  use  of  patent  foods,  which  are  prac- 
tically devoid  of  fat,  some  of  which,  however,  do  contain 
considerable  dried  casein. 

M^hen  the  child  is  suckled  and  the  milk  is  deficient  in  fat 
it  is  often  very  difficult,  with  the  best  theoretical  feeding  of 
the  mother,  to  modify  sufficiently  the  composition  of  her 
breast  milk.  In  such  an  emergency.  Dr.  Holt  has  suggested 
the  feeding  to  the  infant  just  before  each  nursing  a  tea- 
spoonful  or  more,  as  may  be  necessary,  of  cream. 

A  number  of  hints  concerning  the  subject  of  constipation 
and  various  digestive  disorders  will  be  found,  under  their 
respective  headings,  in  the  second  part  of  the  book. 


DISORDERS  ASSOCIATED  WITH  IMPROPER  FEEDING  129 

HYGIENIC  TREATMENT   OF  CONSTIPATION 

After  the  first  year  and  until  a  pretty  varied  vegetable 
diet  is  permissible— a  period  of  about  three  years— a  good 
deal  of  difficulty  is  often  experienced  with  constipation. 
All  through  this  period  fats  are  useful.  Cream  is  the 
best  form,  but  in  its  absence  butter  and  other  animal  fats 
may  be  used,  the  effect  upon  digestion  being  watched. 
When  the  laxative  cereals  can  be  eaten  with  cream  they 
diminish  the  difficulty.  So  do  the  laxative  fruits  already 
mentioned.  And  the  use  of  green  vegetables  or  other  laxa- 
tive vegetable  food  generally  enables  the  parent  to  control 
the  condition  of  the  child's  bowels,  if  attention  is  paid  to 
certain  hygienic  rules,  without  the  resort  to  medicinal 
remedies. 

It  ought  to  be  mentioned  that  the  free  use  of  water  is  as 
useful  in  many  cases  of  infantile  constipation  as  with  adults, 
especially  when  the  evacuations  are  very  hard  and  dry.  The 
water  is  best  taken  on  rising,  before  food,  not  given  to  dilute 
a  meal. 

The  hygienic  considerations  just  alluded  to  relate  to  the 
posture,  time,  and  regularity  of  defecation.  As  to  posture, 
it  hardly  need  be  said  that  the  natural  one  is  that  of  squat- 
ting. In  it,  with  the  body  slightly  bent  forward,  all  the 
muscles  used  in  evacuating  the  bowel  are  in  the  best  posi- 
tion for  efficient  action.  When,  however,  a  child  is  put  upon 
its  chair  commode  its  posture  is  often  such  as  to  render  the 
expulsion  of  hard  fasces  exceedingly  difficult.  The  trunk 
is  bolt  upright,  the  feet  dangle  from  a  seat  which  is  too 
high,  and  the  expulsive  power  of  the  abdominal  muscles  is 
reduced  to  a  minimum.  Besides,  the  aperture  in  the  seat 
of  the  chair  is  so  wide  that  no  support  is  given  to  the  seat- 
bones,  the  fleshy  buttocks  are  crowded  together  instead  of 
separated,  and  the  descent  of  the  parts  necessarily  prelimi- 
nary to  evacuation  is  much  hindered.  If  a  child  be  rachitic, 
its  difficulties  are  in  every  way  increased.  In  all  cases  of 
constipation  it  is  better  to  use  a  low  vessel  than  a  chair, 

9 


130  THE  CENTURY  BOOK  FOR  MOTHERS 

unless  the  latter  be  a  very  low  one.  The  writer  was  once 
consulted  concerning  a  child  because  it  would  never  use  its 
chair,  no  matter  how  long  it  was  left  upon  it;  but  immedi- 
ately afterward  would  go  to  a  corner  of  the  room  for  its 
evacuation.  The  poor  infant  could  not  do  otherwise,  for  the 
reasons  just  given. 

The  element  of  time  is  important.  The  matter  to  be  evac- 
uated may  not  be  in  the  lower  bowel,  or  even  if  it  be  there, 
the  impulse  to  expel  it  may  not  come  immediately,  and  a 
certain  amount  of  delay  becomes  necessary.  When  chil- 
dren are  of  school  age  this  factor  becomes  a  pretty  impor- 
tant one  in  inducing  habitual  constipation.  Time  enough 
between  breakfast  and  school-time  cannot  be  allowed,  and 
the  function  is  forgotten  until  some  time  when  it  becomes 
imperative.  Therefore  it  is  far  better  that  school  children, 
if  habitually  constipated,  shall  be  obliged  to  take  some  other 
time  of  the  day,  one  which  they  can  always  devote  to  the 
purpose,  preferably  when  the  parent  or  attendant  can  know 
of  the  result. 

This  last  requirement,  regularity,  is  so  important  that 
it  is  very  generally  appreciated.  It  cannot  be  too  much 
insisted  upon,  and  it  alone  corrects  many  cases  of  con- 
stipation. 

MASSAGE 

If  dietetic  and  hygienic  measures  are  inadequate,  there 
are  still  some  other  resources  \\dthin  the  scope  of  domestic 
practice.  The  first  to  be  mentioned  is  massage  of  the  abdo- 
men. The  only  objection  to  it  arises  from  the  ticklishness 
of  some  children,  but  if  the  masseuse,  mother  or  nurse,  re- 
members that  the  pressure  of  the  fingers  is  to  be  made  as 
if  to  reach  something  beyond  the  skin  the  tickling  does  not 
follow  as  it  does  from  too  light  a  touch.  It  is  best  that  the 
massage  should  not  be  applied  while  the  stomach  is  quite 
full.  The  following  is  a  simple  method  which  works  very 
well:  Slightly  anoint  the  fingers  of  one  hand  with  vaseline 
or  some  other  lubricant  to  protect  the  skin  from  irritation. 


DISORDERS  ASSOCIATED  WITH  IMPROPER  FEEDING  131 

Beginning  rather  low  down  on  the  right  side  of  the  abdomen 
with  the  tips  of  the  fingers  make  little  circular  movements, 
advancing  upward  to  the  neighborhood  of  the  ribs,  then 
cross  to  the  opposite  ribs  and  then  down  upon  the  left  side 
toward  the  groin.  After  a  moment's  rest,  the  performance 
is  repeated,  and  so  on  for  a  number  of  minutes,  say  five,  the 
time  being  increased  if  the  shorter  sittings  are  ineffectual, 
and  two  sittings  a  day  may  be  given  if  necessary.  If  the 
operator  pictures  to  herself  an  imaginary  body  within  the 
bowel  which  she  desires  to  coax  along  from  the  right  flank  up 
and  across  and  doMTi  through  the  course  of  the  large  intestine 
she  will  pretty  certainly  hit  upon  the  correct  manipulations. 
Similar  ones  may,  if  necessary,  be  applied  to  the  whole 
abdomen. 

^\Tien  other  devices  become  necessary,  there  lies  a  choice 
betw^een  laxative  medicines,  suppositories,  and  enemata.  As 
to  which  is  the  most  preferable— i.  e.,  which  has  most  ad- 
vantages and  fewest  disadvantages— all  are  not  agreed,  nor 
is  it  probable  that  the  answer  should  be  the  same  for  all 
cases.  The  writer's  preferences  on  the  whole  are  in  this 
order:  suppositories,  enemata,  and  laxatives. 


SUPPOSITORIES 

In  many  cases  the  suppository  must  act  merely  by  exciting  a 
reflex  action  in  the  bowel  or  by  bringing  the  child 's  attention 
to  the  desired  act.  For  we  often  find  that  the  simple  intro- 
duction of  an  oiled  syringe-nozzle  or  an  oiled  paper  lamp- 
lighter is  promptly  followed  by  an  evacuation.  Among 
popular  remedies  we  find  simple  suppositories  shaped  of  mo- 
lasses candy  and  soap.  The  latter  has  a  decidedly  stimu- 
lating action,  and  its  prolonged  use  is  said  often  to  cause 
local  irritation.  Probably  the  kind  of  soap  has  much  to  do 
with  this,  but  in  any  case  where  the  oiled  soap-cone  is  used 
signs  of  local  trouble  should  be  watched  for.  Glycerin  sup- 
positories are  much  used,  and  often  for  a  long  time  without 
harm,  but  the  same  watchfulness  should  be  given  to  them,  as 


132  THE  CENTURY  BOOK  FOR  MOTHERS 

glycerin  is  not  a  bland  substance  to  all  persons.  Medicated 
suppositories  should  not  be  used  without  specific  medical 
advice,  and  it  is  unfortunately  true  that  some  suppositories, 
sold  under  very  innocent  sounding  names,  often  produce  the 
evidences  of  strong  medication  upon  the  system. 

ENEMATA  AND   LAXATIVE  MEDICINES 

The  occasional  use  of  the  enema  belongs  properly  to  the 
nursery.  Its  prolonged  use  should  not  be  adopted  without 
medical  advice.  The  same  is  still  more  true  of  laxative 
medicines. 

It  is  to  be  borne  in  mind  that  medicinal  treatment  for 
habitual  constipation  is  not  to  be  adopted  until  a  thorough 
and  careful  attempt  to  correct  the  difficulty  by  diet  and 
hygiene  has  been  made  and  failed. 

VARIETIES   OF   DIARRHOEA 

DiARRHCEA,  as  the  word  is  here  used,  means  any  disorder 
in  which  the  evacuations  from  the  bowels  are  increased  in 
number  and  diminished  in  solidity.  It  is  not  true  that  all 
forms  of  diarrhoea  are  due  to  faulty  feeding,  but  for  the 
practical  purposes  of  the  nursery  it  is  so  nearly  true  that  it 
may  be  so  assumed.  Different  kinds  of  diarrhoea  are  de- 
scribed and  are  classified  according  to  the  views  of  authors. 
Those  most  commonly  recognized  are : 

Simple  diarrhoea,  meaning  a  slight,  brief  diarrhoea,  gener- 
ally due  to  undigested  food,  occasionally  to  chilling  or  to 
heat  and,  but  rarely,  to  the  process  of  teething. 

The  summer  diarrhcea,  now  believed  to  be  usually  due  to 
some  bacterial  cause  and  based  upon  some  preceding  errors 
in  diet. 

The  inflammatory  diarrhcea,  probably  due  to  similar 
causes,  but  with  more  pronounced  manifestations,  such  as 
mucus  and  blood  in  the  stools.  These  last-named  peculi- 
arities of  the  stool  usually  are  considered  to  constitute 
dysentery. 


DISORDERS  ASSOCIATED  WITH  IMPROPER  FEEDING  133 

The  name  cholera  infantum  is  often  used  to  characterize 
the  last-mentioned  type  of  diarrhoea.  It  is  a  misuse  of  the 
name,  and  often  gives  undue  alarm.  The  true  cholera  in- 
fantum is  a  rather  rare  disease,  characterized  by  symptoms 
very  similar  to  those  of  real  cholera— namely,  very  watery, 
colorless  discharges,  usually  vomiting,  fever,  and  very  rapid 
exhaustion.  It  is  probably  dependent  upon  some  special 
poison,  which  is  most  likely  one  generated  in  bad  milk.  As 
the  destructiveness  of  this  type  of  diarrhoea  is  well  known, 
it  is  a  pity  to  give  its  alarming  name  to  either  summer  diar- 
rhoea or  inflammatory  diarrhoea,  as  is  often  done. 

RULES   FOR  ALL  CASES  OF  DIARRHOEA 

For  the  physician  the  discussion  of  the  various  diarrhoeal 
diseases  and  their  management  is  a  long  one.  But  for  the 
nursery  guardian  the  rules  are  few  and  simple.  It  is  safe 
to  assume  that  some  error  of  feeding  has  occurred.  Either 
the  cow's  milk  as  given  has  for  some  reason  not  been  what  it 
should  have  been,  or  other  improper  food  has  been  given, 
or  more  food  than  the  child  could  digest,  or  it  has  been  so 
frequently  given  that  the  digestive  organs  have  had  no  rest, 
or  the  child  was  not  in  a  condition  to  digest  what  ordi- 
narily would  have  been  proper,  and  so  on.  Therefore  it  is 
advisable 

First  of  all,  always  to  clear  out  the  digestive  tract  to  re- 
move improper  or  fermenting  substances  likely  to  be  there. 
Despite  its  unpleasantness,  castor-oil  maintains  its  place  as 
the  most  desirable  remedy.  If  it  is  retained,  its  action  is  more 
satisfactory  than  that  of  any  other  drug.  If  there  is  vomit- 
ing or  much  nausea  it  may  be  better  to  facilitate  the  clear- 
ing of  the  stomach  by  giving  large  draughts  of  warm  water, 
which  will  be  pretty  certainly  rejected.  Calomel  is  a  cathar- 
tic which  has  the  advantages  of  helping  to  allay  the  stomach 
disturbance,  as  well  as  to  disinfect  the  canal. 

Second,  if  the  cathartic  does  not  put  an  end  to  the  diar- 
rhoea it  is  wise  to  ask  medical  advice.     The  same  is  true  if 


134       THE  CENTURY  BOOK  FOR  MOTHERS 

vomiting  continues  after  the  stomach  has  been  cleaned  out, 
as  vomiting  and  fever  may  be  a  symptom  of  many  disorders 
besides  those  of  the  digestive  organs. 

Third,  the  child  is  to  be  kept  quiet  and  recumbent,  best 
in  bed. 

Fourth,  the  digestive  tract  should  be  given  as  complete  a 
rest  as  possible.  Suckled  children  rarely  have  diarrhoea  so 
long  as  they  have  no  other  nourishment.  Children  partly 
or  wholly  artificially  fed,  however,  seem  liable  to  these  dis- 
orders in  a  general  way  in  proportion  as  their  diet  departs 
from  the  natural  standard.  Therefore  all  solid  food  and  all 
cow's  milk  should  be  stopped.  Water  (and  in  nursery  sick- 
ness water  means  that  which  has  been  boiled  and  cooled) 
may  be  given  in  small  quantities,  and  more  freely  if  the 
stomach  is  quiet.  If  food  is  required,  rennet  whey,  with 
or  without  wine,  and  white-of-egg  water  have  both  the 
indorsement  of  tradition.  The  egg  mixture  is  made  from 
the  white  of  one  egg,  half  a  pint  of  water,  seasoned  slightly 
wdth  salt.  The  white  sugar  formerly  added  is  better 
omitted.  It  is  usual  to  add  brandy,  say  a  teaspoonful. 
This  mixture  is  given  by  spoonfuls.  If  much  is  given  to  a 
young  child  the  amount  of  brandy  need  not  be  so  great  in 
proportion. 

These  simple  measures  are  applicable  to  all  the  varieties 
of  diarrhoea  at  the  beginning.  They  may  cure  the  malady, 
and  in  any  case  what  has  been  done  will  be  of  assistance  to 
the  physician  if  his  services  are  required. 

STOMACH   INDIGESTION   AND   COLIC 

The  same  general  rules  are  applicable  to  the  treatment  of 
stomach  indigestion.  If  the  trouble  be  but  recent,  unloading 
the  stomach  and  bowels,  rest  of  the  body,  and  especially  of 
the  digestive  organs  usually  restore  the  normal  condition  in 
a  few  days. 

One  other  ailment  of  the  digestion,  more  troublesome  than 
dangerous,  but  causing  in  the  aggregate  a  good  deal  of  suf- 


DISORDERS  ASSOCIATED  WITH  IMPROPER  FEEDING  135 

fering  is  intestinal  colic,  usually  due  to  flatulence  and  popu- 
larly called  wind-colic.  It  is  found  chiefly  in  the  earlier 
months  of  infancy,  both  in  suckled  and  fed  children,  but  is 
nevertheless  usually  due  to  indigestion,  and  this  to  some 
disproportion  between  the  food  and  the  individual  digestive 
powers.  The  picture  of  the  contorted  face,  the  spasmodic 
cry  of  pain,  the  hard  abdomen,  and  the  drawn-up  limbs  is 
familiar  to  most  nurses.  As  the  gas  causing  the  pain  is  in 
the  bowels  it  is  much  more  promptly  expelled  if,  instead  of 
giving  medicine  (carminative  teas,  etc.),  enemas  to  start  in- 
testinal action  are  used.  A  few  ounces— three  or  four— are 
sufficient  for  an  enema  in  young  infants.  Lukewarm  water 
is  useful.  The  writer  has  found  a  weak  tea  of  catnip  or 
mint  leaves,  especially  the  former,  given  warm,  more  efficient 
when  used  as  an  enema  than  when  given  by  mouth.  A  small 
amount  of  glycerin  is  a  very  efficient  addition  to  the  water 
of  an  enema;  for  four  ounces,  from  fifteen  drops  upward 
may  be  added,  according  to  the  age  of  the  infant.  Hot  ap- 
plications, preferably  dry,  are  also  useful.  Friction  or  gen- 
tle manipulations  of  the  bowels  with  the  hand  seem  to  stimu- 
late the  intestine  to  expel  the  gas. 

If  the  infant  be  artificially  fed  the  habit  of  colic  may  be 
corrected  by  more  perfectly  adjusting  the  food  to  the  diges- 
tion. If  the  child  be  suckled  this  is  more  difficult,  often 
impracticable. 


THE  EVIDENCES  OF   ILLNESS 

IT  is  not  necessary,  even  if  it  were  desirable,  that  the 
mother  or  nurse  should  be  able  to  make  a  diagnosis  of 
the  nature  of  any  disease  that  a  child  may  have;  but  it  is 
very  desirable  that  she  should  be  able  to  recognize  the  symp- 
toms of  illness.  These  may  be  so  direct  and  simple  that 
they  indicate  the  disease.  At  all  events,  they  should  con- 
vey to  the  mother  the  information  that  the  child  is  not  well 
and  in  need  of  help,  either  hers  or  that  of  a  physician.  If 
she  has  familiarized  herself  with  the  signs  of  health  she  will 
easily  recognize  departures  from  them.  Below  are  some  of 
the  commoner  ways  in  which  a  child  manifests  that  it  is  not 
well,  and  may  possibly  indicate  its  malady. 

GENERAL  BEHAVIOR 

Deportment.  The  usual  expression  of  discomfort  is  rest- 
lessness and  fretfulness.  Sleep  is  disturbed,  the  quiet  baby 
is  no  longer  so,  but  desires  attention,  wants  to  be  taken  up,  or 
in  other  similar  ways  shows  that  it  is  not  at  ease.  Less  fre- 
quently, children  in  illness,  especially  if  the  temperature  be 
raised,  become  unusually  heavy  and  drowsy. 

Posture  may  vary  somewhat  in  accordance  with  the  just 
mentioned  nervous  states— that  is  to  say,  the  restless  child 
constantly  changes  its  position,  while  the  heavy  one  may 
lie  perfectly  quiet  in  one  position,  without  much  apparent 
preference  as  to  what  that  particular  one  shall  be.  Special 
postures    often    are    indications    of    particular    conditions. 

136 


THE   EVIDENCES  OF  ILLNESS  137 

Thus,  the  head  may  be  bent  backward  and  the  neck  stiffened, 
or  there  may  be  a  boring  motion  of  the  head  with  some 
inflammation  of  the  brain  envelops  (meningitis).  If  there 
is  labored  breathing  from  any  cause  the  child  may  be  un- 
willing to  lie  down,  and  require  to  be  held  or  propped  up. 
If  there  be  pain  in  the  abdomen  the  limbs  are  generally 
drawn  up.  Many  postures  are  assumed  to  avoid  exciting 
local  tenderness  or  pain. 

Pain  is  expressed  not  only  by  cries  but  sometimes  by  ex- 
pressive gestures.  Often  the  child's  hand  is  put  to  the  seat 
of  the  pain. 

Of  local  symptoms  a  few  may  be  mentioned. 


THE   HEAD,  FACE,  AND  EYES 

The  Head.  Unusual  shapes  are  gradually  assumed  in  rick- 
ets (see  p.  125),  and  in  hydrocephalus,  or  chronic  *' water 
on  the  brain."  But  as  evidence  of  acute  illness,  heat  of 
the  head,  signs  of  headache,  as  shown  by  putting  hands  to 
the  head ;  unwillingness  to  move  the  head  quickly,  may  be 
instanced.  If  the  child  has  the  fontanelle  still  unclosed  its 
throbbing  may  be  used  for  counting  the  pulse  more  easily 
than  at  the  wrist.  It  can  be  done  by  sight.  If  the  head  be 
fuller  of  blood  than  usual,  as  is  sometimes  the  case  in  fever, 
the  fontanelle  may  be  prominent.  In  wasting  diseases  or 
with  very  poor  nutrition  it  may  be  sunken. 

The  expression  of  the  countenance  as  a  whole  tells  not  a 
great  deal,  except  the  difference  between  comfort  and  dis- 
comfort, but  the  various  parts  of  the  face  often  are  expres- 
sive.    Thus : 

The  eyes  are  frequently  suffused  in  illness,  especially  at 
the  approach  of  cold  beginning  as  nasal  catarrh  (''cold  in 
the  head")  or  of  measles.  If  the  eye  itself  be  inflamed  or 
sensitive  it  may  be  red  or  the  child  may  avoid  the  light  by 
closing  them  or  by  turning  the  head.  In  disease  the  pupils 
may  be  enlarged  or  contracted,  but  rather  as  evidence  of 
existing  mischief  than  as  a  forerunner  of  trouble.     A  for- 


138       THE  CENTURY  BOOK  FOR  MOTHERS 

eign  body  in  the  eye  generally  excites  spasm  of  the  eyelids 
and  a  flow  of  tears.  Sleeping  with  half-closed  eyes,  if  seen 
in  illness,  generally  denotes  depression. 

The  sides  of  the  nostrils  are  seen  to  move  in  respiration  in 
conditions  of  labored  breathing,  especially  pneumonia. 

SIGNS  ABOUT  THE  MOUTH 

The  mouth  gives  a  good  many  indications.  If  it  be  kept 
open,  especially  in  sleep,  it  probably  means  obstruction  to 
the  ingress  of  air  through  the  nose.  Enlarged  tonsils  and, 
above  all,  the  pressure  of  an  adenoid  growth  in  the  pharynx 
may  be  suspected  if  the  open  mouth  is  habitual.  If  it  is  an 
accompaniment  of  fever,  more  likely  it  signifies  tonsilitis. 
Children  often  put  their  hands  into  their  mouths  when  the 
gums  are  tender  or  when  the  tonsils  are  painful,  as  well  as 
when  they  are  hungry.  Eruptions  are  seen  about  the  lips, 
especially  at  the  corners  of  the  mouth,  in  various  ailments. 
The  breath  gives  notice  by  its  bad  odor  of  disordered  stom- 
ach, as  well  as  of  diseases  of  the  nasal  and  pharyngeal  mucous 
membrane.  The  gums  are  swollen  with  teething,  swollen  and 
easy  to  bleed  in  infantile  scurvy.  The  upper  surface  of  the 
tongue  presents  a  great  variety  of  coatings  in  various  disor- 
ders. That  which  is  of  most  importance  in  the  nursery  is  the 
whitish  or  grayish  overlaying  (not  the  whitish  tongue  of  the 
very  young  baby)  which  exists  in  a  multitude  of  disturbed 
conditions,  but  which  is  generally  considered  as  indicating 
some  stomachic  derangement,  most  likely  due  to  improper 
feeding.  Interrupted  drinking  or  suckling  or  difficulty  in 
swallowing  suggests  some  obstruction  to  a  free  supply  of  air, 
such  as  collections  in  the  nostrils,  swollen  tonsils  or  adenoids, 
or  even  some  pulmonary  troubles. 

THROAT  TROUBLES 

The  throat  and  fauces  can  be  readily  examined  by  plac- 
ing the  child  upon  the  lap  of  another  person  in  such  a  way 
that  it  faces  the  light.     The  child's  head  is  held.     The  ob- 


THE  EVIDENCES  OF  ILLNESS  139 

server  then  depresses  its  chin  to  open  its  mouth,  and  if  the 
child  cries  no  depression  of  the  tongue  is  usually  necessary. 
If  it  does  not  cry,  the  tongue  may  be  gently  and  quickly 
depressed  by  some  small,  smooth,  flat  implement ;  the  smooth 
handle  of  a  teaspoon  is  the  traditional  one.  A  single  glance, 
if  fortunate,  shows  if  the  tonsils  be  swollen,  if  they  have 
any  white  spots  or  patches  upon  them  or  on  other  parts 
of  the  throat.  It  is  not  easy  to  describe  the  differences 
between  the  spots  of  the  ordinary  '^  follicular  tonsilitis"  and 
the  patches  of  the  diphtheritic  variety.  In  fact,  the  bac- 
teriological study  of  such  matters  has  to  a  very  great  degree 
broken  down  the  distinctions  formerly  made.  So  far  as 
anything  can  be  stated,  it  is  this:  that  spots  on  the  tonsils 
alone  w^hich  show  no  tendency  to  spread  or  to  run  together 
are  probably  not  diphtheritic.  Those  which  do  spread  or 
unite,  and  spots  on  the  palate,  in  the  pharynx  ("back  of  the 
throat"),  or  in  the  nose  probably  are  diphtheritic.  But 
the  distinction  is  not  to  be  certainly  made,  even  by  a  physi- 
cian, without  microscopic  evidence.  Hence,  any  sore  throat 
should  be  isolated,  and  if  any  patches  or  spots  are  seen  it 
is  better  to  have  a  physician's  opinion.  ''Sore  throats" 
are  not  to  be  slightingly  treated,  since  there  is  good  reason 
to  think  that— aside  from  diphtheria— they  are  the  infective 
starting-point  for  enlarged  glands,  rheumatism,  and  other 
constitutional  disorders,  not  to  mention  nearly  all  ear 
troubles. 

THE  VOICE 

The  voice  and  cry  vary  with  the  disturbance.  The  tired 
''worry"  of  a  sleepy  child  is  sometimes  heard  in  illness. 
The  explosive  cries  of  anger  and  fright  are  not  evidence  of 
illness.  The  hoarse  note  heard  in  both  cry  and  cough,  the 
latter  resembling  a  bark,  shows  laryngeal  inflammation— 
that  is,  croup.  In  obstructive  croup  the  sound  is  much 
lessened.  When  the  nose  is  obstructed  the  note  of  the  cry 
is  modified,  as  would  be  the  voice  of  an  adult.  The  loud 
cry  of  pain  is  pretty  easily  recognized;  it  is  prolonged  or 


140  THE  CENTURY  BOOK  FOR  MOTHERS 

spasmodic,  in  harmony  with  the  pain,  the  tormenting  pain 
of  earache,  for  instance,  giving  rise  to  a  prolonged  cry,  a 
colic  usually  to  one  which  is  interrupted  and  renewed. 

THE  EARS 

The  ears  give  notice  only  of  troubles  connected  with  them- 
selves, and  then  through  tenderness  of  the  external  ear  when 
touched ;  but  it  is  well  to  discover,  by  touching  or  lightly  tap- 
ping the  bone  behind  the  ear,  if  there  be  tenderness  there, 
as  such  a  symptom  calls  for  prompt  attention.  Discharge 
from  the  ear  is  evidence  of  disease  within,  a  condition  to 
which  too  little  attention  is  often  given. 

BREATHING 

The  warnings  from  the  chest  usually  come  through  altered 
breathing  or  through  coughing.  The  respiration  of  an  in- 
fant is  much  faster  in  health  than  that  of  an  adult,  and  is 
somewhat  less  regular.  The  respiration  is  hurried,  with 
a  rise  in  temperature,  and  roughly  in  proportion  to  the  de- 
gree of  rise,  the  pulse  usually  rising  also  symmetrically. 
In  pulmonary  inflammation  the  rate  of  respiration  often, 
but  not  always,  rises  out  of  proportion  to  the  pulse-rate  and 
the  fever.  Slowing  of  respirations  below  the  normal  ordi- 
narily may  mean  some  brain  disturbance,  such  as  the  men- 
ingitis caused  by  tubercle  or  poisoning  from  opium.  Very 
disordered  rhythm  of  breathing,  rising  and  falling,  are  no- 
ticed in  some  brain  troubles.  Difficulty  of  breathing,  such, 
for  instance,  as  is  caused  by  obstructions  in  the  Avindpipe, 
by  diphtheritic  croup,  produce  the  breathing  known  as 
''labored,"  in  which  all  the  accessory  muscles  that  can  help 
respiration  are  called  into  service. 

VARIOUS   COUGHS 

Coughs  have  a  good  deal  of  character.  The  resounding 
metallic  bark  of  common  "spasmodic"  croup  has  just  been 


THE  EVIDENCES  OF  ILLNESS  141 

alluded  to.  No  warning  need  be  attached  to  it,  for  it  com- 
pels attention.  The  smothered,  hoarse  cough  of  laryngeal 
obstruction  is  really  more  alarming  to  the  physician.  The 
cough  of  throat  irritation  is  usually  short  and  teasing.  That 
of  bronchitis  is  pretty  frequent,  and  not  usually  very  tight, 
while  if  the  chest  be  sore  there  is  apt  to  be  a  little  cry  with 
or  after  it.  The  cough  of  pneumonia  is  tighter,  seems  to 
be,  and  probably  is,  suppressed  on  account  of  pain,  and  the 
child  has  no  breath  to  waste  in  crying.  In  fact,  it  is  sur- 
prising to  see  to  what  an  extent  a  child  with  this  disease  will 
sometimes  refrain  from  crying  and  eating,  apparently  to  save 
breath.  The  cough  of  influenza,  when  characteristic,  is  per- 
sistent, pestilent,  and  wearing,  often  recalling  that  of  whoop- 
ing-cough. The  cough  of  this  latter  disease  is  so  characteris- 
tic that  without  its  peculiar  ^' whoop"  the  diagnosis  may 
remain  uncertain.  The  patient  begins  with  a  cough,  a  little 
spasmodic,  which  is  repeated  more  and  more  rapidly,  without 
proper  inspirations,  until  the  stomach  is  emptied  by  vomit- 
ing or  the  paroxysm  ends  with  a  long  crowing  inspiration, 
which  is  the  ''whoop."  The  performance  may  then  be  re- 
peated. 

VOMITING 

The  stomach  empties  itself  much  more  easily  in  infancy 
than  later.  The  overfull  suckling  regurgitates  its  sur- 
plus without  an  effort,  and  this  return  is  not  a  sign  of 
illness.  Real  vomiting,  however,  is  often  seen  as  evidence 
of  stomach  indigestion  (tough  curds,  etc.),  as  well  as  of 
other  stomach  and  bowel  troubles.  It  is  a  frequent  initial 
symptom  of  some  of  the  eruptive  fevers,  notably  scarlatina, 
also  of  pneumonia  and  of  malarial  fever.  In  the  latter  two 
disorders  initial  chills  are  rarely  seen  in  young  children, 
while  vomiting  or  convulsion  instead  is  not  rare.  Peculiar 
types  of  vomiting  are  seen  in  special  diseases,  such,  for  in- 
stance, as  the  so-called  ''projectile"  vomiting  associated  with 
some  brain  disorders,  the  matter  being  suddenly  and  vio- 
lently ejected;  vomiting  often  attends  the  rally  from  the 


142  THE  CENTURY  BOOK  FOR  MOTHERS 

stunned  condition  (concussion)  arising  from  a  blow  or  fall 
upon  the  head.  The  vomiting  of  whooping-cough  seems  to 
be  merely  a  mechanical  result  of  the  violence  of  the 
paroxysm. 

The  abdomen  w\\\  help  to  make  a  diagnosis  in  case  of 
colic.  It  is  then  usually  distended,  hard,  and,  if  tapped 
upon,  resonant.  The  retracted  abdomen  of  some  brain  trou- 
bles is  rarely  an  early  symptom. 

THE   URINE  AND   BOWEL  DISCHARGES 

The  urine,  which  in  infancy  is  pale,  clear,  and  of  little 
odor,  may  in  illness  become  scanty,  darker,  and  sometimes 
have  fine  reddish  grains,  which  can  be  seen.  When  these 
are  very  minute  they  may  be  known  only  by  the  stain  on 
the  diaper.  Granules  large  enough  to  be  seen  may  cause 
pain  in  passing.  Medicines  may  stain  the  urine.  Santon- 
ine,  an  ingredient  of  some  worm  lozenges,  gives  it  a  saffron 
color,  which  may  stain  the  napkins.  Children  who  eat  as- 
paragus pass  urine  having  the  familiar  offensive  odor  of  the 
eliminated  asparagin. 

The  stools  are,  in  a  healthy  infant,  characteristically  yel- 
low, the  depth  of  the  tint  bearing  some  relation  to  the 
strength  of  the  food.  The  stools  often  undergo  a  change 
of  color  to  green  soon  after  they  are  passed,  sometimes 
without  any  derangement  of  health.  Stools  persistently 
green  when  passed  generally  denote  intestinal  disturbance. 
Lack  of  bile  in  the  movements  gives  a  gray  color,  often 
called  ''clay-colored,"  and  this  may  be  even  chalky.  Some 
medicines  color  the  stools.  Bismuth  is  the  most  striking  in 
its  effect,  as  its  stain  is  an  olive-green,  which  may  be  bluish 
or  even  nearly  black.  Iron  also  blackens  stools.  Any  con- 
siderable blood  in  a  movement  coming  from  some  distance 
up  the  canal  may  make  it  black  and  sticky  in  consistency. 
Curds  in  the  stool  denote  indigestion.  Mucus  (which  in 
health  is  incorporated  with  the  fecal  matter)  is  evident  and 
often  streaked  with  blood  in  inflammations  of  the  intestinal 
canal  (inflammatory  diarrhoea). 


THE  EVIDENCES  OF   ILLNESS  143 


FEVERS 


The  sJcin  gives  indications  of  fever  by  its  heat  and  dry- 
ness. It  will  often,  if  examined  carefully,  show  various 
eruptions,  which  may  be  those  of  the  special  eruptive  fevers, 
or  may  be  some  of  the  various  skin  manifestations  indicative 
of  digestive  or  nutritional  disturbances.  The  former  erup- 
tions will  be  alluded"  to  in  connection  with  symptoms  of 
these  fevers. 

Temperature.  Since  the  introduction  of  the  fever  ther- 
mometer it  is  no  longer  necessary  to  judge  of  the  degree  of 
fever  by  the  touch.  The  latter  will  be  deceptive  if  the  skin 
of  the  child  be,  as  may  happen,  moist  as  well  as  hot,  or  if 
the  hand  of  the  mother  be  either  unusually  hot  or  cold  from 
anxiety.  A  thermometer  can  now^  be  had  for  a  dollar,  or 
a  little  more,  which  will  register  in  a  minute  or  two.  The 
temperature  is  best  taken  in  the  rectum.  The  thermometer 
is  first  washed  and  dried,  the  registering  index  shaken  down 
below  the  marked  normal  point,  the  bulb  end  anointed  with 
vaseline  or  some  other  unguent,  and  then  gently  slipped 
into  the  bowel  about  an  inch.  After  a  minute  or  two,  or 
longer  if  the  instrument  be  a  slow  one,  it  is  gently  removed 
and  the  temperature  read  from  the  top  of  the  registering 
index.  The  bowel  gives  the  full  heat  of  the  body  more  com- 
pletely than  the  mouth,  armpit,  or  groin.  The  instrument  is 
again  cleaned  and  put  away. 

The  temperature  is  not  a  fixed  indication  of  degree  of 
illness.  Its  value  must  be  taken  in  connection  with  many 
other  things.  A  temperature  which  would  be  trivial  from 
one  cause  may  give  the  physician  much  anxiety  if  from 
another.  It  seems,  therefore,  unwise  to  set  up  any  figure 
as  the  mark  of  great  danger.  It  may,  however,  be  fairly 
said  that  temperatures  from  100°  F.  to  102.5°  or  103°  consti- 
tute what  is  usually  called  moderate  fever;  from  103°  to 
105°  high  fever;  above  that  point  very  high  or  exceptional 
fever.  The  height  of  the  fever,  the  disease  being  the  same, 
corresponds  fairly  well  with  the  severit}^  of  the  attack. 
Probably  of  more  importance  than  the  point  marked  at  any 


144       THE  CENTURY  BOOK  FOR  MOTHERS 

one  time  is  the  duration  of  the  fever.  The  indication 
of  fever,  if  of  more  than  very  moderate  amount,  is  to 
call  for  medical  help,  unless  the  temperature  promptly 
yields. 

Given  a  fever  of  the  range  denominated  moderate  or  high, 
its  meaning  may  be  often  guessed  from  the  attendant  symp- 
toms. Thus,  if  with  smart  fever  the  child  cries  much  and 
puts  its  hand  to  its  head  or  ear  the  trouble  is  very  likely 
in  the  latter,  especially  if  throat  trouble  has  preceded.  Fever 
with  the  signs  of  sore  throat  described  make  tonsilitis  prob- 
able. Fever  with  cough  suggests  bronchitis  or  pneumonia, 
and  so  on. 


SYMPTOMS  OF  CONTAGIOUS   DISEASES 

While,  as  already  said,  it  is  not  the  purpose  of  this  book 
to  enable  the  mother  to  recognize  and  treat  diseases,  it  is 
desirable  that  she  should  have  knowledge  of  the  symptoms 
which  are  usual  in  the  beginning  of  contagious  diseases, 
especially  of  the  eruptive  fevers,  since  with  these  the  patient 
needs  to  be  promptly  isolated  from  other  children.  It  can 
hardly  be  too  much  insisted  on  that  every  sick  child  should 
be  as  far  as  possible  isolated,  not  only  for  its  own  advantage, 
but,  until  it  is  positively  known  that  its  disease  is  not  con- 
tagious, for  the  safety  of  others. 

These  contagious  disorders  have  a  number  of  peculiarities 
in  common,  besides  the  fact  that  the  temperature  is  elevated. 
First  they  have  a  period  of  incubation— thsit  is,  a  period 
between  the  exposure  which  is  the  source  of  infection  and 
the  very  first  symptom.  This  period  is  more  variable  in 
some  diseases  than  in  others,  and  some  variations  exist  for 
all.     Thus,  it  is  for 

Scarlatina,  from  one  day  to  three  weeks,  but  most  cases 
appear  within  a  week,  a  majority  within  four  days  after 
exposure. 

Measles,  usually  between  eleven  and  fourteen  days,  but 
much  wider  variations  in  both  directions  exist. 


THE  EVIDENCES  OF  ILLNESS  145 

German  measles  has  the  same  wide  variation,  but  most 
cases  develop  between  the  eighth  and  the  sixteenth  day. 

Whoopi7ig-coiigh,  probably  between  one  and  two  weeks. 
It  comes  on  so  gradually  that  it  is  difficult  to  be  sure  of  its 
exact  beginning. 

Mumps,  usually  from  two  and  a  half  to  three  weeks. 

Chicken-pox,  usually  from  fourteen  to  sixteen  days. 

Varioloid  (that  is,  small-pox  modified  by  earlier  vaccina- 
tion), ten  to  fourteen  days. 

Small-pox,  usually  twelve  days.  Vaccination,  two  to 
four  days,  commonly  four  before  there  are  really  noticeable 
effects. 

A  knowledge  of  these  periods  is  helpful,  in  that  if  they 
pass,  after  known  exposure,  without  manifestations  of  dis- 
ease, it  may  be  considered  that  contagion  has  probably  not 
taken  place. 

THE  INVASION   PERIOD 

Secondly,  these  diseases  have  a  period  of  invasion,  in  popu- 
lar language,  ' '  when  children  are  coming  down  with ' '  this  or 
that  disease.  The  invasion  of  an  ordinary  case  of  scarlatina 
is  usually  marked  by  abrupt  rise  of  fever,  vomiting,  occa- 
sionally a  convulsion,  sore  throat,  which  looks  red,  and  the 
eruption,  following  in  from  twelve  to  thirty-six  hours.  Mea- 
sles begins  with  irritation  of  the  eyes,  sneezing,  running  from 
the  nose,  and  a  very  irritating  cough.  Certain  spots  in  the 
mouth  are  thought  to  indicate  measles,  but  they  are  not  easily 
recognized  without  training.  The  eruption  comes  after 
from  two  to  four  days.  Measles  is  one  of  the  most  con- 
tagious of  diseases,  and  may  be  communicated  from  the 
beginning  of  the  symptoms.  The  fever  of  measles  gener- 
ally rises  rather  gradually  until  the  rash  is  well  started, 
then  gradually  declines. 

German  measles  has  a  very  brief  invasion— a  few  hours — 
and  often  the  eruption  is  the  first  thing  noticed.  Other 
symptoms,  if  any,  are  usually  similar  to  those  of  measles,  but 
much  less  marked. 

10 


146  THE  CENTURY  BOOK  FOR  MOTHERS 

Chicken-pox  has  little  fever,  the  eruption  appearing  within 
twenty- four  hours. 

Mumps  has  but  slight  fever,  and  the  local  symptoms  are 
such  that  they  can  hardly  be  mistaken,  especially  if  the 
disease  is  known  to  be  prevalent. 

CHARACTERISTIC  ERUPTIONS 

The  eruptions  are  for  the  most  part  distinctive.  That  of 
scarlatina  is  made  up  of  such  minute  red  points  as  to  ap- 
pear an  even  red.  It  first  appears  on  the  neck  and  chest. 
If  looked  for,  it,  or  something  very  like  it,  can  be  often  seen  in 
the  throat  before  it  appears  upon  the  skin.  Once  it  begins 
upon  the  skin  it  spreads  gradually  over  the  whole  body,  dis- 
appearing in  the  same  order.  It  continues  from  three  to 
seven  days.  The  desquamation  or  ''peeling"  begins  soon 
after  the  rash  has  gone.  The  epidermis  often  falls  off  in  large 
pieces.  It  may  last  many  weeks,  even  two  months.  The 
time  of  greatest  communicability  is  during  the  periods  of 
active  eruption  and  the  desquamation.  So  long  as  the  latter 
continues  anywhere  the  patient  is  a  source  of  contagion. 
Mild  cases  are  often  very  dangerous  in  this  regard,  as  they 
are  not  always  carefully  watched. 

The  eruption  of  measles  is  much  darker  in  color,  is  made 
up  of  dark  red  or  purplish  spots,  sometimes  raised  slightly. 
These  spots  are  usually  gathered  in  small  patches,  often 
described  as  crescentic,  although  not  very  strictly  of  that 
shape,  spaces  of  clear  skin  intervening  between  them.  In 
very  profuse  eruptions  the  patches  sometimes  run  together. 
The  eruption  usually  is  first  found,  if  looked  for,  behind  the 
ears,  but  oftener  is  first  noticed  on  the  face  and  forehead.  It 
spreads  during  two,  three,  or  more  days  over  the  body,  fades 
in  the  same  order,  lasts  usually  from  four  to  six  days,  and 
desquamates  in  fine  pieces.  The  eruption  of  German  mea- 
sles appears  first  upon  the  face ;  sometimes  it  may  be  found 
still  earlier  on  the  roof  of  the  mouth.  Sometimes  it  spreads 
like  the  other  eruptions,  sometimes  seems  to  come  all  at 


THE  EVIDENCES  OF  ILLNESS  147 

once.  It  is  remarkable  for  its  variability  in  appearance. 
More  commonly  it  is  a  good  deal  like  the  eruption  of  measles, 
but  appears  in  larger  alid  more  solid  blotches  of  spots. 
Again,  it  may  quite  closely  resemble  that  of  scarlatina.  It 
is  sometimes  quite  difficult  to  discriminate,  and  the  disease 
is  perhaps  more  important  from  the  trouble  it  creates 
through  mistakes  than  from  its  own  gravity.  The  rash  usu- 
ally lasts  two  or  three  days.  It  has  been  thought  that  more 
than  one  disease  may  be  really  included  in  the  name  of  Ger- 
man measles.  Chicken-pox  has  an  eruption  of  distinct,  scat- 
tered, slightly  raised,  flattened  spots,  many  of  which  progress 
to  the  formation  of  blisters  (vesicles).  These  dry  into  crusts, 
beginning  in  the  middle  of  the  vesicles.  The  eruption  ap- 
pears in  crops,  so  that  the  various  stages  may  be  seen  to- 
gether after  a  few  days.  Whooping-cough  has  no  eruption, 
and,  as  has  been  said,  its  one  certain  symptom  is  the  peculiar 
cough. 

PERIODS  OF   ISOLATION 

The  quarantine  period  of  these  diseases  differs.  Scarla- 
tinal patients  must  be  isolated  as  long  as  any  desquamation 
is  observed  anywhere.  It  lingers  longest  on  the  hands  and 
feet.  The  poison  clings  in  a  remarkable  manner  to  the  sick- 
room and  to  articles  in  it.  Hence  the  need  of  very  thorough 
disinfection.  Measles  generally  has  completely  gone  by  the 
end  of  four  weeks,  and  the  contagion  rarely  lingers  in 
articles  about  the  patient.  It  seems  to  be  to  a  great  degree 
personal. 

German  measles  is  a  disease  of  such  ordinarily  mild  be- 
havior that,  except  in  institutions,  quarantine  is  rather 
lax  regarding  it,  provided  the  diagnosis  of  the  disease  is 
sure. 

Whooping-cough  is,  like  measles,  very  contagious,  and, 
like  it,  communicable  from  the  very  beginning  of  symptoms. 
Its  characteristic  symptom— the  whoop— is  so  long  in  appear- 
ing that  the  sufferers  are  usually  allowed  to  go  about  a  long 
time  after  the  disease  is  communicable.     How  long  it  is 


148        THE  CENTURY  BOOK  FOR  MOTHERS 

communicable  is  not  well  settled.  Probably  it  is  so  for  three 
months  on  the  average,  and  the  quarantine  should  be  contin- 
ued for  some  time,  a  week  or  two  certainly,  after  the  patient 
has  ceased  to  whoop. 

Mumps  also  is  thought  to  be  contagious  for  a  considerable 
time. 


XI 

DOMESTIC  TREATMENT  OF  ILLNESS 

THE  domestic  treatment  of  illness,  if  it  be  wise,  is  little 
more  than  skilful  nursing.  As  the  mother  gains  expe- 
rience, she  may  venture  upon  some  simple  medications.  As 
the  skilled  physician  of  to-day  usually  relies  more  and  more 
upon  hygiene  and  the  application  of  physiological  know- 
ledge, and  less  and  less  upon  medication,  so  wise  domestic 
medicine  will  have  little  of  dosing  in  it.  It  is  assumed  that 
if  a  child  be  really  ill  a  physician  Avill  be  called.  Often  it 
will  prove  that  if  he  had  been  called  early  a  single  visit  would 
have  been  enough;  bad  domestic  medicine  leads  to  his  being 
obliged  to  pay  many. 

The  mother,  if  she  sees  the  evidence  of  some  illness,  may 
think  it  unnecessary  to  send  for  a  physician,  and  may  be 
quite  right  in  so  thinking.  But  she  may  wish  to  do  some- 
thing for  the  child's  relief.  Her  first  endeavor  will  be  to 
try  to  learn  what  is  the  trouble  "v\dth  the  child.  She  may 
know  of  exposures,  fatigues,  errors  of  diet,  or  even  of  con- 
tagious maladies  to  which  it  may  have  been  exposed.  If 
she  has  any  idea  of  the  nature  of  the  malady,  or  if  she  can 
note  only  symptoms,  her  next  thought  should  be.  What  am 
I  trying  to  do?  The  answer  should  be,  ^^I  am  trying  to 
relieve  this  or  that  symptom,"  in  which  case  she  is  likely  to 
do  no  harm,  at  the  least.  This  is  emphasized  because  in 
practice  the  physician  too  often  can  see  no  reason  for  the 
treatment  which  has  been  given  before  he  arrives,  except  a 
nervous,  anxious  desire  to  **do  something."  If,  then,  the 
mother  asks  herself.  Will  this  remedy  relieve  the  symptom? 

149 


150  THE  CENTURY  BOOK  FOR  MOTHERS 

will  its  employment  throw  any  obstacle  in  the  way  of  the 
proper  treatment  of  the  case  if  further  treatment  be  neces- 
sary? she  has  a  fair  chance  to  cure  the  child  herself,  and, 
if  not,  she  has  helped  the  physician  to  do  it. 

PRECAUTIONARY  MEASURES 

First,  she  may  put  the  child  to  bed.  This  alone  is  a  reme- 
dial measure.  The  mere  undressing  of  the  child  may  reveal 
some  previously  unnoticed  symptom.  The  putting  of  the 
child  into  bed  takes  it  off  a  drafty  floor,  and  removes  the  dis- 
comforts of  clothing,  and  recumbency  relieves  many  an  irri- 
tation due  to  activity.  At  the  beginning  of  ' '  a  cold  "  or  of  a 
diarrhoea  it  may  be  of  considerable  service.  A  child  who,  if 
allowed  to  play  around  half  sick  till  bedtime,  would  have  a 
feverish  night  may  have  a  far  more  comfortable  one  if  it  has 
been  put  to  bed  as  early  as  it  is  discovered  to  be  ailing.  The 
infant  practically  is  abed  most  of  the  time,  and  this  sug- 
gestion is  not  very  useful  at  its  early  age,  except  so  far  as 
meaning  that  the  little  one  is  to  be  put  into  the  more  com- 
fortable night  garments.  Do  not  burden  it  with  unnecessary 
coverings. 

It  is  sometimes  objected  that  the  child  does  not  like  to  go 
to  bed.  This  brings  up  one  of  the  most  important  matters 
in  the  care  of  sick  children— namely,  the  habit  of  obedience. 
The  child  who  has  been  taught  to  obey  and  obey  promptly 
rarely  rebels  in  illness.  Habitual  wilfulness  balks  all  en- 
deavors for  the  child's  benefit.  Slight  illnesses  become  con- 
siderable ones,  severe  ones  become  perilous.  It  is  no  exag- 
geration to  say  that  lives  are  sometimes  lost  through  the 
resistance  that  a  \vilful  child  may  make.  It  not  only  fa- 
tigues the  attendants,  but  wears  out  its  ovm  strength.  It 
is  well  known  that  such  children  often  obey  a  trained  nurse 
better  than  a  member  of  the  family,  and  it  is  true,  however 
regrettable,  that  in  some  nurseries  there  is  no  difficulty  if 
the  physician  has  no  helper  but  the  ordinary  nursery- 
maid, while  if  the  mother  or  the  father  be  present,  proper 


DOMESTIC  TREATMENT  OF  ILLNESS  151 

examination  or  treatment  of  the  little  patients  is  nearly 
impossible. 

THE  WARM   BATH 

Baths  are  among  the  most  efficient  remedial  agencies  at  our 
command,  and  are  accessible  to  nearly  every  one.  Baths 
are  named  according  to  temperature,  different  writers  classi- 
fying them  in  a  slightly  different  way.  Only  three  baths 
have  a  place  in  illness  without  medical  direction— the  tepid 
bath,  85°  F.  to  91°  F. ;  the  warm  bath,  91°  F.  to  blood-heat, 
98.6°  F. ;  the  hot  bath,  any  temperature  above  blood-heat. 
If  it  be  a  bath  for  immersion  of  the  whole  body,  104°  F.  or 
105°  F.  will  usually  be  the  limit  of  tolerance.  It  is  doubt- 
ful if  there  is  any  disease  at  the  beginning  of  which  a  warm 
bath  may  not  be  safely  given  to  a  child  previously  well. 
In  almost  any  state  of  irritation  it  soothes  the  nervous  system, 
as  well  as  the  skin.  It  is  also  to  be  remembered  that  al- 
though its  temperature  is  very  nearly  that  of  the  body  in 
health,  if  there  be  four  to  six  degrees  of  fever  the  bath  will 
be  quite  a  little  below  that  abnormal  temperature,  and  tem- 
porarily will  diminish  it,  with  corresponding  diminution  of 
discomfort.  It  is  this  warm  bath  which  is  most  commonly 
and  judiciously  used  in  illness.  It  will  be  noticed  that  its 
application  has  been  just  now  restricted  to  the  beginning  of 
illness.  This  is  because  there  are  some  diseases,  especially 
those  of  the  chest,  in  the  course  of  which  baths  should  not 
be  given  without  specific  directions,  and  because  in  the  course 
of  eruptive  fevers,  in  which  they  are  often  very  valuable, 
there  are  conditions  in  Avhich  they  must  be  given  with 
caution. 

The  hot  bath  is  very  stimulating,  is  useful  in  case  of 
chill  or  chilling,  and  is  often  applied  to  hasten  the  appear- 
ance of  an  eruption  which  is  believed  to  be  imminent  but  de- 
layed. It  is  of  more  limited  use  than  the  warm  bath,  and 
is  to  be  employed  with  more  caution.  The  tepid  bath  is 
used  when  a  more  distinct  depression  of  temperature  is 
desired  than  will  be  produced  by  a  warm  bath. 


152  THE  CENTURY  BOOK  FOR  MOTHERS 

MEDICATED  BATHS 

Baths  may  be  medicated  in  some  ways  for  especial  pur- 
poses. Thus,  for  certain  irritations  of  the  skin  an  alkaline 
hath  may  be  desirable.  Such  a  condition  is  seen  in  the  well- 
known  prickly-heat  of  summer,  or  in  nettle-rash  or  hives. 
If  to  a  warm  or  tepid  bath  enough  soda— either  the  car- 
bonate, ''washing-soda,"  or  the  bicarbonate,  "baking-soda" 
—is  added  to  give  the  water  a  slightly  slippery  feeling  be- 
tween the  fingers  the  bath  is  more  likely  to  allay  the  itching 
than  a  simple  bath  would  be. 

Similarly,  for  some  skin  irritations,  as  in  some  cases  of  ec- 
zema, a  hran  hatli  has  a  beneficial  influence.  It  is  made  by 
boiling  a  bag  of  bran  and  adding  the  water  in  which  it  has 
been  boiled  to  the  bath,  or  by  squeezing  the  bag  of  bran  in 
the  hot  water  in  the  bath-tub,  which  will  meantime  cool 
sufficiently  for  use.  A  similar  effect  can  be  obtained  by 
adding  starch  to  the  bath,  or  to  the  alkaline  bath  just  men- 
tioned. 

Salt  added  to  the  bath  increases  its  stimulating  power, 
making  it  comparable  to  sea  bathing.  The  salt  baths  are 
chiefly  useful  in  debility,  and  may  be  used  for  children  too 
young  or  too  feeble  for  sea  bathing,  or  at  seasons  when  and 
in  places  where  the  latter  is  not  obtainable. 

Mustard  is  a  still  more  stimulating  addition  to  the  bath. 
Unlike  salt,  its  application  is  in  acute  conditions,  and  only 
for  a  short  time.  It  must  be  used  very  cautiously  in  a  gen- 
eral bath,  for  fear  of  too  great  irritation  of  the  tender  skin 
of  childhood.  Its  greatest  use  is  in  a  foot-bath  or  hip-bath, 
often  used  to  relieve  symptoms  of  congestion  in  the  head  or 
chest,  as  in  the  beginning  of  a  "cold." 

Disinfectants  may  be  added  to  baths  when  it  is  thought 
that  contagion  lingers  about  the  skin.  As  this  most  com- 
monly occurs  after  contagious  eruptive  diseases  it  is  prob- 
able that  the  physician  will  direct  the  most  desirable  form 
of  bath.  I\Iany  of  the  most  efficient  antiseptics  are  not  quite 
safe  for  indiscriminate  use  in  the  bath.     A  salt  bath  of  good 


DOMESTIC  TREATMENT  OF  ILLNESS  153 

strength,  say  a  pound  of  salt  to  eight  gallons  of  water,  is 
itself  disinfectant  to  some  degree.  The  skin,  after  drying, 
can  be  rubbed  with  alcohol,  which  is  a  good  antiseptic. 
Among  safe  disinfectant  drugs,  boric  acid  and  salicylic  acid 
may  be  mentioned,  but,  owing  to  their  cost,  they  would 
better  be  used  in  a  sponge-bath,  after  a  thorough  cleansing 
in  the  ordinary  bath. 

HOW  TO  GIVE  BATHS 

A  FEW  words  may  be  said  about  methods  in  giving  baths. 
A  child's  ordinary  bath-tub  may  be  used,  but  if  the  bath  be 
much  hotter  or  cooler  than  the  child  is  used  to,  especially  if 
the  tub  be  of  metal,  it  is  better  to  place  in  the  tub  a  sheet  or 
large  towel  to  prevent  the  body's  touching  the  tub  and  get- 
ting a  shock.  If  a  warm  bath— and  still  more  if  a  hot  bath- 
has  been  given,  the  child  should  be  lifted  immediately  into  a 
blanket  or  warmed  sheet,  and  rolled  up  and  not  dressed  until 
the  skin  is  dry  and  the  change  a  little  recovered  from. 

If  it  be  desired  to  give  a  tepid  or  even  cooler  bath,  and 
shock  be  feared,  or  the  child  be  timid  or  excitable,  the  object 
may  be  accomplished  by  what  is  known  as  the  "graduated" 
bath— that  is,  one  of  gradually  changing  temperature.  If 
the  ordinary  set  tub  be  used,  a  tube  of  rubber  can  be  first 
adjusted  to  the  inlet  of  the  cold  water.  This  is  hidden  by 
the  bath-sheet.  A  warm  bath  is  drawn,  and  when  the  child 
has  been  in  it  a  minute  or  two  the  cold  tap  is  very  slightly 
opened  and  the  water  allowed  to  run  very  slowly,  until  the 
desired  temperature  of  the  bath  is  shown  by  the  bath-ther- 
mometer. 

The  duration  of  a  bath  varies  with  the  temperature.  A 
warm  bath  should  ordinarily  not  be  continued  beyond 
ten,  or  at  most  fifteen,  minutes.  A  hot  bath  must  be  verj^ 
brief.  It  is  better  to  repeat  the  immersion  if  necessary, 
after  a  little  while,  than  to  make  the  first  one  unduly 
long.  The  same  is  equally,  if  not  more,  true  of  cooler 
baths. 


154  THE  CENTURY  BOOK  FOR  MOTHERS 

SPONGE-BATHS 

When  cool  or  cold  baths  seem  called  for  it  is  better,  in  the 
absence  of  medical  advice,  to  give  them  in  the  form  of 
sponge-baths.  The  child,  lying  upon  a  blanket  or  bathing- 
sheet,  and  lightly  covered,  can  be  sponged  part  by  part 
until  the  desired  alleviation  of  the  discomfort  or  symptom 
is  gained.  Exact  indications  for  the  use  of  hot  or  cool  baths 
cannot  be  well  given,  as  they  depend  upon  states  of  the 
pulse  and  circulation  not  appreciated  without  training.  In 
a  general  way,  it  may  be  said  if  the  child  is  weak  or  depressed 
give  only  the  warm  bath. 

VAPOR-BATHS 

If,  on  the  other  hand,  it  be  desired  to  excite  perspiration 
rapidly  and  profusely,  a  t;apor-bath  will  be  an  efficient 
method.  If  there  be  a  croup-kettle  obtainable,  it  is  the  most 
convenient  way  of  making  steam.  In  its  absence,  steam 
from  a  tea-kettle  may  be  made  use  of.  In  either  case  the 
bed-clothing  is  to  be  raised  tentwise,  either  by  hoops  beneath 
or  a  cord  from  above,  and  the  vapor  introduced  underneath 
them  by  a  pipe.  For  a  child  able  to  sit  up  the  ancient 
method  of  a  chair  sweat  may  be  employed.  The  child  was 
placed  in  a  chair,  an  ordinary  wooden-bottomed  kitchen 
chair  or  a  cane-seated  one;  a  blanket  was  drawn  about  the 
child  and  chair,  inclosing  both  as  in  a  tent,  the  head  alone 
appearing  through  the  top.  Upon  a  heated  brick  or  stone, 
placed  in  a  basin  under  the  chair,  hot  water  was  allowed  to 
slowly  drip.  The  heat  of  the  stone  or  brick  vaporized  the 
already  heated  water.  In  the  same  way  a  hot-air  bath  may 
be  extemporized,  the  heat  being  obtained  from  heated  stones 
as  before,  from  a  vessel  of  hot  water,  or  even,  ^Yith.  proper 
precautions,  by  means  of  burning  alcohol— the  traditional 
''rum-sweat"  of  New  England.  The  hot-air  bath  is  even 
more  efficient  than  the  vapor  in  inducing  perspiration.  It 
can  be  very  easily  given  in  bed  by  using  an  elbow  of  metal 


DOMESTIC  TREATMENT  OF  ILLNESS  155 

pipe  (stovepipe,  for  instance) .  One  arm  goes  under  the  ele- 
vated bed-clothes  as  before.  The  other  extends  down  toward 
the  floor.  Under  its  open  end  a  lamp,  preferably  an  alcohol 
lamp,  is  placed.     The  hot  air  rises  into  the  bed. 

COLD  COMPRESSES 

If  it  be  desired  to  reduce  locally  the  heat  of  any  part,  the 
usual  resources  are  cold  compresses  or  ice-hags.  The  former 
are  simply  folded  cloths  or  pledgets  of  absorbent  cotton 
dipped  in  cool  or  iced  water  and  squeezed  just  enough  to 
prevent  the  water  from  flowing.  They  are  laid  upon  the 
part— the  eye,  for  instance— in  which  it  is  desired  to  dimin- 
ish the  flow  of  blood,  and  hence  to  limit  the  inflammation  of 
the  part.  For  cooling  a  larger  surface,  the  ordinary  rubber 
water-bag  may  be  partly  filled  with  cold  water  and  applied 
to  the  part.  Ice-bags  more  suitable  to  special  applications 
are  made  of  thin  rubber,  which  adjust  themselves  to  the  sur- 
face quite  perfectly.  The  ice-cap  is  the  commonest  example 
of  these.  The  opening  is  large  enough  to  admit  pieces  of 
ice  of  considerable  size,  and  is  stopped  with  a  cork.  These 
ice-bags,  however,  are  rather  beyond  simple  domestic  medi- 
cine, as  without  previous  direction  their  use  is  not  sure  to 
be  advisable. 

HOT  APPLICATIONS 

Heat  may  be  applied  locally  by  means  of  the  hot-water 
bag  now  in  common  use.  If  several  sources  of  heat  are 
needed  they  usually  are  to  be  had  in  bottles  of  hot  water,  in 
hot  bricks  or  stones  (all,  of  course,  to  be  enveloped  in  wrap- 
pings, preferably  of  wool),  in  bags  of  sand,  or  of  salt  heated 
in  the  oven. 

A  moist  local  application  of  heat  constitutes  a  fomenta- 
tion. Usually  cloths  wrung  out  of  hot  water  are  used, 
applied  over  the  part  where  pain  is  to  be  eased  or  to  the  sur- 
face of  which  it  is  desired  to  attract  the  blood.  The  stimu- 
lating effect  may  be  increased  by  sprinkling  the  surface  of 


156  THE  CENTURY  BOOK  FOR  MOTHERS 

the  wrung-out  cloth  with  tincture  of  camphor.  Applica- 
tions of  spirits  of  turpentine  used  in  this  way  or  simply 
sprinkled  upon  a  dry  cloth  and  applied  are  called  stupes, 
but  the  word  really  means  any  fomentation.  Turpentine 
stupes  and  stupes  of  hot  mustard-water  are  very  stimulat- 
ing to  the  skin,  but  should  be  used  with  the  greatest  care 
on  children  too  young  to  quickly  express  their  feelings,  as 
an  undesirable  amount  of  irritation  can  be  easily  produced. 
Mustard  should  not  be  used  upon  an  unconscious  person. 
The  chief  use  of  stupes  is  in  cases  of  abdominal  troubles. 
Camphorated  oil  produces  a  gentle  stimulation  of  the  skin, 
and  is  a  popular  remedy  in  infantile  chest  disorders.  It  is 
however  doubtful  if  it  be  of  great  value. 

POULTICES 

If  it  be  desired  to  make  a  more  prolonged  local  action  of 
heat,  poultices  may  be  used.  Their  chief  use  is  where  heat 
and  moisture  are  desired  upon  the  skin;  sometimes  they  are 
of  a  nature  to  be  directly  soothing  to  the  parts  beneath. 
They  may  be  made  from  many  substances,  as,  for  instance, 
any  kind  of  meal,  of  which  flaxseed-meal  has  the  best  con- 
sistency for  the  purpose,  or  ground  slippery-elm  bark,  which 
has  no  particular  advantage  over  the  flaxseed  and  is  much 
dearer;  bread  and  Avater,  or  bread  and  milk.  Various  vege- 
tables, such  as  onions  and  potatoes,  have  had  popular  repute 
for  this  purpose. 

The  traditional  uses  of  poultices  are  to  quiet  local  inflam- 
mations and  to  hasten  suppuration  when  it  is  inevitable,  as  in 
ordinary  boils.  Formerly  they  were  used  for  many  pur- 
poses to  which  a  hot-water  bag  is  now  applied.  The  use 
of  large  poultices  upon  the  chest  in  disorders  of  that  region, 
especially  in  pneumonia,  is  common.  They  are  probably  use- 
ful if  skilfully  used,  but  otherwise  they  are  not.  To  rouse 
the  feeble  respiration  of  a  sick  child  the  poultices  must  be 
applied  hot,  but  not  too  hot;  must  be  changed  frequently, 
every  half  hour  at  the  longest,  and  changed  with  speed,  the 


DOMESTIC  TREATMENT  OF  ILLNESS  157 

new  one  being  ready  before  the  old  one  is  removed.  All  this 
requires  dexterity,  and  usually  two  pairs  of  hands. 

Poultices  should  not  be  used  carelessly.  Never  poultice 
an  eye  \dthout  specific  order  of  the  physician. 

Stimulant  poultices  are  made  by  adding  to  the  ordinary 
material  some  proportion  of  mustard.  A  mustard-plaster 
is  a  poultice  entirely  or  largely  of  mustard.  For  young 
children  the  latter  are  usually  to  be  avoided.  Plasters  made 
in  a  similar  manner  from  the  various  ordinary  spices  are 
warm  enough  for  young  skins. 


HOW  TO  APPLY   POULTICES 

The  making  and  application  of  poultices  require  a  little 
knack  or  knowledge.  The  materials  used  may  be  various,  as 
just  mentioned.  Whatever  is  used,  the  mixture  must  be, 
when  done,  entirely  smooth ;  nothing  hard  or  harsh  is  admis- 
sible. If  bread  and  milk  or  bread  and  water  be  the  materials, 
the  boiling  water  should  first  be  poured  into  a  hot  bowl,  or 
the  water  may  be  heated  in  a  saucepan.  In  either  case  the 
bread-crumb,  no  crust,  should  be  broken  into  it  and  the 
whole  beaten  together  with  a  fork,  to  keep  the  mass  as  light 
and  soft  as  possible.  Flaxseed-meal  or  ground  elm-bark  may 
be  stirred  into  the  hot  water  and  heated  till  the  mass  boils 
or  steams  and  becomes  soft.  A  poultice  should  not  be  so 
stiff  as  to  be  harsh,  nor  so  thin  as  to  run.  A  beginner  is 
likely  to  use  too  much  water. 

Any  soft,  thin  fabric  of  sufficient  strength  will  do  for 
a  poultice  cloth.  Of  late  years  the  porous  materials  known 
as  cheese-cloth  and  butter-cloth  have  in  great  degree  dis- 
placed others.  They  are  very  suitable  to  the  purpose,  and 
so  very  cheap  that  they  may  be  thrown  away  without  thought. 
Bags  of  these  materials  of  suitable  size  may  be  made,  into 
which  the  poultice  mass  is  filled  when  ready,  and  the  open 
side  stitched  up,  or  a  suitable  piece  of  the  stuff  may  be  laid 
upon  a  hot  plate  and  the  mass  spread  half  an  inch  thick  or 
more,  the  edges  turned  over  and  stitched  together  if  they 


158  THE  CENTURY  BOOK  FOR  MOTHERS 

do  not  remain  in  place  without.  The  poultice  should  be 
always  large  enough  to  considerably  more  than  cover  the 
surface  to  be  acted  upon;  a  boil,  for  instance,  having  a  red- 
dened surface  two  and  one  half  inches  across,  will  require 
a  poultice  four  inches  square  at  least. 

One  of  the  inconveniences  of  poultices  is  their  drying  and 
sticking  to  sensitive  surfaces  or  to  parts  upon  which  short 
hairs  grow.  This  may  to  a  great  degree  be  obviated  by  first 
putting  oil  or  vaseline  upon  the  surface  of  the  skin  or  of 
the  poultice;  and  both  the  drying  and  cooling  may  be  hin- 
dered by  placing  over  the  poultice  a  piece  of  oiled  silk  or 
gutta-percha  tissue,  and  over  it  again  some  cotton  batting, 
the  whole  to  be  kept  in  place  by  a  bandage  or  the  like.  The 
older  method  of  making  poultices  covered  on  one  surface 
only  with  cloth  favored  this  sticking,  but  the  open-textured 
kinds  of  poultice  cloth  mentioned  may  cover  both  surfaces 
of  the  poultice  mass,  one  lying  between  the  latter  and  the 
skin. 

In  putting  on  a  poultice  let  it  approach  the  surface  to 
w^hich  it  is  to  be  applied  gradually,  and  put  it  in  place  as 
soon  as  the  heat  can  be  borne.  It  usually  needs  renewal  in 
a  few  hours— two  to  four,  on  an  average. 

In  the  absence  of  any  suitable  poultice  material,  a  tem- 
porary substitute  may  be  found  in  a  thick  piece  of  cotton 
batting  or,  still  better,  absorbent  cotton,  dipped  in  hot  water, 
pressed  partly  dry,  and  applied  and  treated,  as  to  covers, 
as  advised  for  a  poultice. 

JACKETS   FOR  THE  CHEST 

So,  also,  some  of  the  advantages  of  a  poultice  may  be  ob- 
tained by  the  use  of  the  cotton  and  oiled-silk  jacket  for 
the  chest.  Without  the  oiled  silk,  the  cotton  simply  makes 
an  additional  protection  against  chilling.  It  has  the  ad- 
vantages and  disadvantages  of  excessive  clothing.  When  the 
oiled  silk  is  used  the  perspiration  converts  the  cotton  into 
a  permanent  poultice.     This  was,  not  may  years  ago,  a  rou- 


DOMESTIC  TREATMENT  OF  ILLNESS  159 

tine  application  in  pneumonia.  It  is  probably  much  less 
used  at  present.  The  jacket  is  made  of  muslin  or  similar  ma- 
terial, made  to  go  quite  around  the  chest  and  hollowed  out  to 
admit  the  arms.  To  it  the  layer  of  cotton  is  basted  thor- 
oughly to  prevent  its  shifting.  A  soft  inner  lining  in  addi- 
tion is  still  better.  It  is  tied  around  the  chest  and  over  the 
shoulders  with  tapes  arranged  for  the  purpose.  If  oiled 
silk  is  used,  it  is  modeled  to  fit  the  shirt,  and  also  tied  in 
place. 

CATHARTICS 

In  a  great  many  of  the  disorders  of  infancy  and  child- 
hood evacuation  of  the  bowels  by  remedies  is  necessary  or 
advantageous.  In  fact,  it  is  rarely  out  of  place.  In  child- 
hood the  intestinal  canal  very  often  contains  improper  food 
or  an  excessive  amount  of  food  otherwise  proper.  In  in- 
fancy the  intestinal  contents  are  often  the  results  of  imper- 
fect digestion  of  food.  In  all  these  conditions  the  clearing 
out  of  the  canal  is  essential  to  the  prompt  relief  of  the  mal- 
ady, even  if  it  be  one  not  immediately  caused  by  the  diges- 
tive state.  Hence  the  important  part  played  by  laxatives 
or  cathartics  in  domestic  medicine.  The  treatment  of  habit- 
ual constipation  is  not  here  considered.  For  clearing  out  the 
canal  promptly  two  remedies  may  be  mentioned.  First,  cas- 
tor-oil. On  the  whole,  it  is  the  surest  and  safest  of  cathartics 
for  domestic  use.  It  not  only  acts  as  such,  but  in  many  dis- 
turbances of  the  digestive  tract  is  additionally  beneficial. 
The  dose  for  clearing  out  the  intestinal  canal  should  be  a 
tablespoonful,  say,  at  four  years  of  age,  half  that— i.  e.,  a 
dessertspoonful— at  one  year,  and  a  teaspoonful  by  a  half 
year  is  usually  well  borne  if  needed. 


CALOMEL 

If  there  is  vomiting  or  nausea,  calomel  is  a  better  cathar- 
tic. It  helps  to  quiet  the  stomach.  There  is  no  difficulty 
in  giving  it.     The  best  method  is  to  use  the  triturates  so 


160  THE  CENTURY  BOOK  FOR  MOTHERS 

generally  found  in  the  pharmacies  at  the  present  time.  Tri- 
turates of  one  tenth  of  a  grain  are  very  convenient  for  gen- 
eral use.  One  hourly  may  be  given  for  several  doses,  ac- 
cording to  the  age  of  the  child.  A  child  of  a  year  may  take 
ten  doses  in  this  manner,  but  if  the  bowels  move  early, 
especially  if  the  greenish  color  of  the  calomel  stool  is  noticed, 
the  doses  should  be  stopped.  Children  bear  calomel  in  pro- 
portionally larger  doses  than  do  adults,  but  this  is  not  a 
reason  for  overdosing. 


THE  GIVING  OF  AN   ENEMA 

When  the  bowels  are  simply  constipated,  an  enema  may 
give  all  necessary  relief,  or  a  suppository  may  serve.  Vari- 
ous syringes  are  recommended  for  enemas  of  children,  but 
it  is  not  usually  worth  while  to  multiply  apparatus,  espe- 
cially if  of  rubber,  which  deteriorates  very  rapidly  if  not 
in  frequent  use.  It  is  better  to  become  expert  in  the  use 
of  some  one  kind.  Hence  the  bulb  or  bag  syringe,  which  can 
be  used  for  many  things,  is  generally  used.  It  is  true  that  if 
the  enema  is  needed  for  a  very  young  infant,  the  syringe 
which  consists  of  a  bulb  with  a  soft-rubber  nozzle,  without 
an  intervening  tube,  is  convenient,  because  it  can  be  used  with 
one  hand.  The  hard-rubber  syringe,  with  a  plunger  or  pis- 
ton, is  convenient  for  giving  definite  amounts  of  medicated 
liquids.  On  the  whole,  the  bag  syringe  is  the  most  conve- 
nient. The  enema,  say  of  soap-suds,  is  prepared  preferably 
in  a  pitcher.  For  a  very  young  baby  a  half  pint  should  be 
prepared,  as  some  will  be  wasted  in  the  syringe.  For  an  older 
child  at  least  a  pint  will  be  needed.  Hang  the  bag  at  a 
small  elevation,  not  over  two  feet  above  the  infant,  as  the 
object  is  to  inject  the  liquid  gently,  as  it  is  thus  less  likely 
to  be  prematurely  expelled.  Attach  a  small  nozzle  to  the 
tube,  and  lubricate  it  with  oil  or  vaseline.  Fold  a  thick 
towel  beneath  the  child's  hips.  When  this  is  ready  pour 
the  enema  into  the  bag.  The  bag  will  slightly  cool  the  liquid, 
so  it  should  be  mixed  more  than  blood-warm.     Introduce 


DOMESTIC  TREATMENT  OF  ILLNESS  161 

the  nozzle,  the  child  being  on  its  back  or  left  side.  Gather 
up  some  folds  of  the  towel  about  the  nozzle,  to  make  pres- 
sure against  the  bowel  so  as  to  help  the  retention  of  the  liquid 
and  open  the  pinch-cock  of  the  tube  attached  to  the  bag.  If 
the  child  after  a  while  endeavors  to  get  rid  of  the  liquid,  close 
the  pinch-cock,  as  the  feeling  may  subside  and  more  be  given. 
If  it  does  not  subside,  the  vessel,  which  was  placed  at  hand 
before  beginning,  is  placed  to  the  child  or  the  child  upon  it. 
One  who  has  learned  to  give  an  enema  well  can  easily 
learn  to  irrigate  the  bowel,  as  may  be  necessary  in  diarrhoeal 
diseases.  But  as  it  will  be  ordered  and  demonstrated  by  the 
physician  it  will  not  be  here  described. 


11 


XII 


HINTS   REGARDING  THE  ADMINISTRATION 
OF  MEDICINES 

THE  giving  of  medicines  often  requires  a  little  tact,  and  a 
knowledge  of  details  helps  exceedingly  to  their  success- 
ful administration.  Before  entering  upon  these  details,  a 
few  general  remarks  may  be  made. 

First  of  all,  we  would  deprecate  the  practice  often  in- 
dulged in  by  the  ignorant,  and  sometimes  by  those  who 
should  know  better,  of  holding  up  the  physician  as  a  buga- 
boo and  the  administration  of  medicine  as  punishment,  or, 
at  the  least,  a  thing  to  be  dreaded.  Medicines  sometimes 
are  unpleasant,  more  commonly  they  need  not  be,  and  in  any 
case  it  is  the  part  of  wisdom  to  prepare  the  way  for  a  possible 
need  by  speaking  of  remedies  as  helpful  rather  than  as 
objectionable,  and  of  the  physician  as  a  family  friend  in 
time  of  need  rather  than  as  a  beadle  or  nursery  executioner. 
This  advice  is  fortunately  now  less  necessary  than  formerly, 
and  the  ''Doctor"  is  in  many  houses  quite  as  popular  in 
the  nursery  as  he  is  anywhere.  And  we  have  known  certain 
pious  frauds  to  work  to  advantage,  such  as  in  families 
w^here  candies  are  rarely  admitted,  to  call  them  always  ' '  med- 
icine, ' '  which  name  therefore  became  associated  with  a  pleas- 
ant rather  than  an  unpleasant  thought. 

Another  general  suggestion  is  this :  Do  not  make  a  parade 
or  fuss  in  getting  your  remedy  ready.  If  anything  of  the 
sort  be  necessary,  let  it  be  done  out  of  the  child's  sight,  and 
the  remedy  be  brought  w^hen  ready  for  administration;  it 
may  then  be  swallowed  without  objection,  while,  if  time  had 

162 


ADMINISTRATION   OF   MEDICINES  163 

been  allowed,  antagonism  would  have  been  excited.     Make 
the  giving  of  each  dose  as  tidy  as  possible. 

If  doses  are  to  be  given  frequently,  or  for  some  time,  it 
is  of  help  to  make  out  on  a  slip  of  paper  a  schedule  of  hours 
for  them,  and  as  each  dose  is  given  draw  a  line  through  that 
hour.  This  shows,  afterward,  not  only  when  the  dose  should 
have  been  given,  but  that  it  was  given.  The  plan  is  espe- 
cially useful  to  avoid  confusion  when  more  than  one  remedy 
is  required.  The  tumbler  covers  with  dials  are  handy,  but 
only  when  the  medicine  is  in  liquid  form. 


LIQUID   MEDICINES 

Liquids  constitute  the  chief  form  of  medicine  given  to  chil- 
dren, owing  to  their  inability,  as  a  rule,  to  take  other  forms. 
If  a  medicine  has  little  taste,  or  at  least  little  disagreeable 
taste,  this  form  is  unobjectionable;  but  otherwise  the  other 
forms  are  preferable  as  soon  as  the  child  is  old  enough  to 
take  them,  as  in  them  taste  can  m  one  way  or  another  be 
hidden.  Medicines  are  sometimes  insoluble,  and  must  then  be 
given  in  some  more  solid  form.  It  should  be  remembered 
that  some  infants  dislike  to  take  anything  into  the  mouth 
except  by  sucking.  It  is  rather  hard  to  teach  such  chil- 
dren to  take  even  a  drink  of  water  from  a  cup  or  from  a 
spoon. 

WAYS  OF  GIVING  MEDICINES 

It  is  of  advantage  to  give  water  even  to  the  youngest  suck- 
ling, and  it  is  an  additional  reason  for  so  doing  that  by 
this  means  the  child  learns  to  take  liquids  from  a  spoon  or 
cup,  and  has  less  difficulty  in  taking  medicine  in  case  an 
emergency  arises.  If  a  medicine  is  prescribed  by  a  physi- 
cian, learn  from  him  just  how  it  is  to  be  given,  even  as  to 
the  amount  of  water  in  which  each  dose  is  to  be  adminis- 
tered. This  latter  point  may  not  be  important  in  many 
cases,  but  in  some  it  may.     For  instance,  saline  medicines 


164  THE  CENTURY  BOOK  FOR  MOTHERS 

largely  diluted  may  act  upon  the  kidneys,  while  if  less  di- 
luted they  would  more  probably  act  upon  the  bowels. 

As  a  rule,  medicines  which  are  in  any  degree  pungent  or 
which  might  be  irritating,  should  be  largely  diluted,  or  water 
be  given  directly  afterward.  On  the  other  hand,  medicines 
which  have  a  decided  taste  should  be  diluted  as  little  as  is 
consistent  with  the  foregoing  rule,  in  order  that  the  disagree- 
able taste  may  not  be  unduly  prolonged.  It  is  not  good 
policy  to  sweeten  such  medicines,  but  rather  to  give  the 
douceur,  whether  a  sweet  or  a  tasty  fruit,  immediately  after- 
ward. Sometimes  a  decided  taste,  as  of  orange  juice,  in  the 
mouth  just  before  the  medicine,  is  an  excellent  disguise, 
especially  if  it  be  repeated  just  afterward.  We  will  speak 
of  this  more  fully  presently. 

HOW  TO   PREPARE  A   DOSE 

If  a  liquid  is  to  be  given  in  doses  of  a  certain  number  of 
drops,  especially  if  given  frequently,  much  time  and  annoy- 
ance may  be  saved  by  mixing  a  number  of  doses  at  once.  For 
instance,  suppose  the  physician  has  ordered  that  a  drop  of 
tincture  of  aconite  be  given  every  hour  or  half  hour  until 
certain  effects  are  produced.  The  giving  of  a  single  drop 
thus  often  is  sometimes  difficult,  especially  with  the  agi- 
tating circumstances  which  attend  a  baby's  illness.  It  is 
then  better  to  put  into  a  tumbler  or  some  other  convenient 
vessel  a  certain  number  of  drops  of  the  medicine,  it  does 
not  much  matter  just  how  many,  if  they  be  counted.  Then 
add  the  same  number  of  teaspoonfuls  of  water,  and  mix  thor- 
oughly by  stirring.  Evidently  each  teaspoonful  will  contain 
one  drop  of  the  aconite,  and  it  is  only  necessary  to  stir  the 
mixture  well  before  each  dose  and  to  take  up  the  teaspoonful 
to  insure  the  proper  quantity.  If  the  dose  is  to  be  larger, 
it  is  easily  obtained  by  giving  the  requisite  number  of  tea- 
spoonfuls,  or,  if  smaller,  by  adding  a  proportionately  larger 
number  of  spoonfuls  of  water  at  the  start.  In  any  case  drop 
out  the  medicine  before  adding  the  water. 


ADMINISTRATION  OF  MEDICINES  165 

IRON   PREPARATIONS 

In  spite  of  the  advances  of  pharmaceutical  chemistry,  it 
is  sometimes  necessary  to  give  solutions  containing  acids 
either  as  such,  or  as  helping  the  solution,  like  some  prepara- 
tions of  iron.  These  solutions  ''set  the  teeth  on  edge,"  and 
fears  are  naturally  entertained,  and  sometimes  with  reason, 
lest  the  teeth  be  injured.  In  such  cases  it  is  well,  unless 
the  physician  has  a  reason  to  the  contrary,  to  resort  to  the 
following  device  to  prevent  harm.  Before  giving  the  dose, 
dissolve  a  little  baking-soda,  say  a  good  pinch,  in  a  third  of 
a  tumbler  of  water ;  warm  water  we  prefer.  As  soon  as  the 
acid  dose  is  taken,  let  the  patient  rinse  the  mouth  with  the 
soda,  which  neutralizes  the  acid  and  removes  the  ''on-edge" 
feeling.  If  the  child  is  too  young  to  do  this,  wash  the  mouth 
with  a  rag  dipped  in  the  soda.  Older  children  can  also  pre- 
vent harm  to  the  teeth  by  the  use  of  a  tube  or  straw  in  tak- 
ing the  acid. 

CASTOR-OIL 

Oily  liquids  require  some  special  attention.  As  has  been  al- 
ready said,  in  domestic  practice,  and  on  the  whole  wisely,  cas- 
tor-oil plays  an  important  role.  But  its  giving  need  not  be 
made  so  difficult  as  it  often  is.  If  the  oil  is  fresh  and  of  good 
quality,  its  taste  is  not  nearly  so  bad  as  that  of  many  things 
more  readily  taken.  If  through  carelessness  the  oil  becomes 
rancid,  it  is  a  nauseous  dose.  Oils  exposed  to  the  air,  espe- 
cially in  warm  places,  easily  undergo  changes,  and  the  follow- 
ing precautions  should  be  observed  as  regards  castor-oil,  cod- 
liver  oil,  emulsions  of  either,  or  of  almond  oil,  often  used  in 
cough  mixtures.  Keep  them  always  in  as  cool  a  place  as  prac- 
ticable. Before  giving  a  dose,  see  that  the  neck  of  the  bottle 
is  clean  on  the  outside.  Pour  out  the  dose  carefully,  and 
clean  the  stopper  and  neck  inside  and  out  before  the  former 
is  replaced ;  then  cork  tightly.  The  reason  of  this  is  that  if  a 
film  of  oil  is  left  exposed  to  the  air  it  soon  becomes  rancid, 
and  in  pouring  the  next  dose  some  of  the  rancid  oil  goes 


166  THE  CENTURY  BOOK  FOR  MOTHERS 

with  it— enough  to  give  a  taste ;  and  when  the  pouring  ceases, 
the  oil  that  returns  to  the  bottle  carries  with  it  some  of  the 
rancid  oil,  enough  often  to  set  up  a  similar  process  in  the 
bottle.  Similar  precautions  are  useful,  but  not  so  neces- 
sary, for  syrups  or  thick  solutions  containing  gum  or  sugar. 

In  administering  oils  (and  we  may  take  the  castor-oil  as 
a  type)  it  should  be  remembered  that  a  good  deal  of  the  ob- 
jectionableness  is  due  to  the  viscidity.  Therefore,  first  heat 
the  spoon  by  immersion  in  hot  water,  or  in  any  other  way. 
If  the  child  is  old  enough  to  be  allowed,  or  to  have  acquired 
a  liking  for,  sapid  things,  it  is  well  to  squeeze  a  little  orange 
juice  into  the  hot  spoon,  then  pour  in  the  oil  and  squeeze  a 
little  more  juice  over  it.  The  heat  of  the  spoon  makes 
the  oil  flow  more  readily,  and  the  juice  above  and  below 
renders  it  hardly  recognizable.  If  the  baby  is  so  young  as 
to  object  to  the  spoon  per  se,  there  is  no  use  in  trying  to  dis- 
guise the  oil,  but  this  heating  of  it  or  of  the  spoon  is  always 
helpful. 

This  is  a  proper  place  to  say  that  we  believe  that  much 
of  the  disgust  manifested  by  children  for  medicines  is  sim- 
ply imitation  of  their  attendants.  When,  many  years  ago, 
we  were  told  by  an  old  physician  that  children  rarely  ob- 
jected to  cod-liver  oil  unless  they  had  seen  their  elders  make 
a  face  at  it,  we  were  surprised ;  but  experience  has  convinced 
us  of  the  correctness  of  the  statement.  So  far  as  we  have 
observed,  more  children  actually  like  cod-liver  oil  emulsions, 
for  instance,  than  object  to  them. 


MEDICINES   IN   SOLID   FORM 

To  little  children,  powders,  pills,  capsules,  and  tablets  are 
often  more  difficult  to  administer  than  any  liquid.  This  is 
frequently  so  because  to  them  swallowing  has  been  an  auto- 
matic act,  and  when  they  endeavor  to  swallow,  even  with 
the  best  intent,  a  small  object,  it  is  likely  to  lodge  in  some 
part  of  the  mouth  over  which  the  child  has  little  control. 
This,  and  not  the  covering  of  the  taste,  is  the  secret  of  the 


ADMINISTRATION  OF  MEDICINES  167 

success  of  the  old-fashioned  device  of  hiding  the  pill  or 
powder  in  a  good-sized  crumb  of  bread.  A  large  and  suffi- 
ciently soft  bolus  is  thus  formed  which  the  tongue  can  readily 
manage.  The  draught  of  water  acts  in  the  same  way.  It 
can  be  swallowed,  and  with  it  goes  the  dose.  This  also  is 
one  of  the  advantages  of  the  wafer-paper  used  in  adminis- 
tering medicines.  Common  thin  white  tissue-paper  will 
serve  to  hide  a  bitter  powder  if  no  better  cover  is  at  hand. 
It  may  then  be  taken  as  a  pill,  placed  well  back  on  the  tongue 
and  swallowed  immediately  with  a  full  draught  of  water. 
The  paper  is  harmless. 


SWALLOWING  MADE  EASY 

There  are  one  or  two  points  about  the  physiology  of  swal- 
lowing which,  if  understood,  are  helpful— namely,  first,  that 
swallowing  is  made  easy  by  the  action  of  the  saliva  moist- 
ening the  mass  to  be  swallowed ;  but  if,  to  avoid  taste,  speedy 
swallowing  Avithout  time  being  allowed  for  insalivation  be 
required,  or  if  by  reason  of  fever  the  mouth  be  dry,  swal- 
lowing will  be  more  than  usually  difficult.  Hence  another 
reason  for  the  drink  of  water.  Secondly,  that,  while  the 
passing  of  the  bolus  to  be  swallowed  through  the  mouth 
proper  is  done  by  the  muscles  of  the  tongue,  which  are  vol- 
untary muscles  even  if  they  act  unconsciously,  when  the 
bolus  reaches  as  far  back  as  the  uvula  it  comes  within  the 
domain  of  muscles  which  act  spasmodically  and  force  it  down 
the  throat.  Every  child  knows  that  if  it  allows  a  candy  to 
get  too  far  back  on  the  tongue,  it  ''slips  down  the  throat." 
Hence,  if  by  reason  of  nervousness  or  of  anything  else  a  pill 
cannot  be  swallowed,  it  is  only  necessary  to  place  it  upon 
the  back  of  the  tongue,  and  it  must  go.  If  there  is  left  a 
sensation  that  it  has  ''stuck"  anywhere,  a  draught  of  water 
will  remove  it. 

Generally  speaking,  a  little  tact  in  the  management  of  chil- 
dren will  avoid  the  unpleasant  scenes  so  often  associated 
with  the  giving  of  medicines. 


168  THE  CENTURY  BOOK  FOR  MOTHERS 

RULES   FOR  THE  SICK-ROOM 

In  taking  care  of  a  sick  child,  the  same  sort  of  common 
sense  is  called  for  as  in  any  other  nursing.  The  cardinal 
rules  are  watchfulness,  quiet,  calm  demeanor,  and  cheerful- 
ness. Fussiness  and  agitation  are  very  communicable.  En- 
gage the  child's  confidence  by  strict  truthfulness  in  what- 
ever you  say,  and  by  gentleness  in  whatever  you  do.  But 
gentleness  is  not  to  be  understood  as  meaning  weakness  or 
lack  of  discipline.  If  a  medicine  or  any  remedy  is  ordered 
it  is  to  be  given,  and  a  gentle  compulsion  is  less  exhausting 
than  weak  controversy.  If  there  is  any  genuine  obstacle  to 
the  execution  of  the  physician's  orders,  if  it  be  explained  to 
him  he  can  doubtless  manage  in  some  other  way. 

In  any  case  in  which  a  physician  is  called,  write  down 
his  orders,  unless  he  does  so  himself  before  he  leaves,  so  that 
there  shall  be  no  misunderstanding.  If  several  things  are  to 
be  done,  make  a  little  schedule  of  the  hours  at  which  they  are 
due.  It  is  quite  convenient  to  have  a  manuscript  book,  such, 
for  instance,  as  school  exercises  are  written  in,  in  which  to 
write  the  physician's  orders.  If  on  the  opposite  page  a 
memorandum  is  made  of  the  nature  of  the  illness  or  of  its 
symptoms  and  of  the  remedies,  quite  a  useful  guide  is  made 
up,  which  is  especially  applicable  to  the  child  concerned, 
perhaps  to  the  entire  family  of  children. 


XIII 
NURSERY   EMERGENCIES 

THE  management  of  emergencies,  due  in  most  part  to 
accidents,  may  be  considered  under  the  head  of  Domes- 
tic Surgery.  In  addition,  there  will  be  mentioned  in  this 
connection  a  few  emergencies  which  are  not  strictly  surgical, 
but  must  be  met  with  surgical  promptness.  A  large  num- 
ber of  medical  situations,  more  or  less  emergent,  are  con- 
sidered in  the  second  part  of  this  book. 

DOMESTIC    SURGERY 

This  covers  the  care  of  some  minor  injuries,  as  well  as  the 
temporary  care  of  more  serious  ones.  Among  the  various 
wounds  to  which  children  are  liable  are  incised  wounds,  or 
clean  cuts;  lacerated  wounds,  or  tears  and  scratches;  punc- 
tured wounds,  such  as  are  made  by  sharp,  slender  stabbing 
things— in  the  nursery,  needles  and  splinters  are  commonest, 
and  later  fish-hooks  and  pointed  tools  are  added.  To  these 
may  be  added  punctured  poisoned  wounds,  commonly  the 
bites  of  insects,  and,  very  rarely,  the  bites  of  animals  which 
may  be  poisonous.  In  dealing  with  any  wound,  the  first 
duty  is  to  make  sure  that  it  is  clean.  If  the  wound  be 
simply  incised  and  made  with  a  clean  blade  it  will  prob- 
ably be  clean  enough  if  washed  with  simple  boiled  water, 
into  which  salt— a  teaspoonful  to  the  pint— is  dissolved.  If 
the  water  be  as  hot  as  can  be  borne,  it  will  considerably  aid 
in  stopping  the  flow  of  blood.  If  the  latter  be  not  rapid, 
it  may  alone  suffice.     If  blood  spurts,  an  artery  has  been 

169 


170  THE  CENTURY  BOOK  FOR  MOTHERS 

cut,  and  the  jet  is  best  stopped  by  pressure  either  upon  the 
spurting-point  or  by  pressing  together  the  lips  of  the  wound. 
Pressure  may  be  made  directly  with  the  fingers  or  with  a 
bit  of  absorbent  cotton,  gauze,  or  linen.  When  all  is  clean 
and  dry,  the  lips  may  be  brought  together  neatly  and  so  held 
by  strips  of  adhesive  plaster  and  covered  with  a  pad  of  gauze 
and  a  bandage.  All  wounds  upon  the  face  require  especially 
careful  adjustment,  on  account  of  future  appearances. 


RAGGED  WOUNDS 

If  the  wound  be  ragged,  such  as  is  made  by  a  scratching 
or  tearing  implement— nails,  tacks,  and  many  similar  ones— 
more  care  will  be  required  in  cleansing  the  wound  and  in 
adjusting  its  edges,  while  the  bleeding  is  usually  more  read- 
ily stopped.  For  this  cleansing,  an  antiseptic  solution  will 
be  needed.  If  no  other  is  at  hand,  the  salt  solution  before 
alluded  to  will  do,  but  it  is  better  to  have  a  saturated  solu- 
tion of  boric  acid  or  a  bichlorid-of-mercury  solution.  Tab- 
lets of  this  latter  salt  are  sold,  one  of  which,  dissolved  in  a 
pint  of  water,  makes  a  solution  of  one  part  in  one  thousand, 
the  usual  strength  for  use.  Cleanse  the  wound  carefully  and 
thoroughly  Avith  a  wad  of  absorbent  cotton  dipped  in  the 
solution  used.  When  it  is  entirely  clean,  dry  and  close  it 
as  before.  Remember  that  the  solution  is  very  poisonous  if 
sw^allowed. 


THE  CLEANSING  OF  PUNCTURED  WOUNDS 

Punctured  wounds  require  even  more  care  in  the  cleansing, 
as  it  is  not  easy  to  be  sure  that  nothing  remains  within. 
When  everything  has  apparently  been  cleaned  out  let  the 
part  be  soaked  in  the  antiseptic  solution  before  wrapping  it 
up.  A  little  different  procedure  is  required  according  to 
the  nature  of  the  puncturing  substance.  A  needle  is  usu- 
ally not  dirty,  but  is  likely  to  break  in  the  flesh.  If  any 
part  projects,  extract  it  with  great  care,  pulling  in  the  line 


NURSERY  EMERGENCIES  171 

of  the  projecting  part.  If  the  needle  be  broken  and  the 
remainder  imbedded,  do  not  throw  away  the  part  which  is 
found  nntil  the  physician  has  seen  it.  It  may  aid  him  in 
finding  the  other  part.  Pins  are  often  not  clean,  but  do  not 
break;  their  wounds  need  cleansing  especially.  Still  more 
is  cleanliness  necessary  after  the  extraction  of  a  splinter, 
as  the  latter  is  quite  likely  to  be  foul.  The  splinter,  if  large, 
can  be  withdrawn  with  the  fingers,  but  if  small  some  sort 
of  forceps  or  tweezers  is  necessary.  Splinters  under  the 
nails  are  particularly  troublesome,  as  they  often  break  off 
close  to  the  nail  margin  and  cannot  be  grasped.  In  the 
absence  of  a  physician  or  any  proper  instrument,  a  penknife 
blade  may  be  used.  It  should  be  first  washed  and  then  made 
clean  by  holding  it  in  the  steam  of  a  tea-kettle  or  in  boiling 
water.  The  nail  can  then  be  scraped  thin  and  notched  with 
the  knife,  and  the  end  of  the  splinter  may  then  be  reached. 
In  case  of  failure,  the  splinter  is  loosened  by  the  suppuration, 
and  usually  is  thus  easily  dislodged.  But  this  last  process  is 
painful,  and  may  involve  risks. 

The  difficulty  in  removing  fish-hooks  comes  from  the  barb. 
They  are  best  removed  by  pushing  the  point  through  the 
fiesh  if  practicable,  when  the  whole  hook  is  drawn  through, 
or  the  barb  broken  off  and  the  hook  withdrawn,  as  may 
seem  easier.  Occasionally  they  are  so  imbedded  as  to  re- 
quire a  knife  for  their  removal.  Fish-hook  wounds  need 
the  antiseptic  application  to  be  pretty  thoroughly  made. 

The  poison  of  insect  punctures  rarely  causes  more  than 
local  irritation.  This  is  usually  relieved  by  alkaline  appli- 
cations, such  as  ammonia  or  soda  in  water,  by  a  solution  of 
borax,  one  or  two  teaspoonfuls  to  a  pint  of  water.  Camphor 
tincture  and  alcohol  are  also  much  used. 

The  wound  of  dog-bite,  while  usually  only  a  punctured 
wound,  may  be  a  poisoned  one.  The  uncertainty  in  this  re- 
gard is  only  indefinitely  prolonged  by  killing  the  dog.  If 
he  be  kept,  and  is  rabid  at  the  time  of  the  biting,  he  will 
not  long  survive,  and  the  necessary  treatment  of  the  wound 
may  be  instituted.     In  all  cases  of  doubt,  and  especially  if 


172       THE  CENTURY  BOOK  FOR  MOTHERS 

the  dog  has  been  killed  or,  as  in  the  case  of  a  vagrant  dog, 
has  escaped,  the  wound  should  be  cauterized  with  a  hot  iron, 
in  addition  to  the  cleansing  mth  the  antiseptic  solution  which 
is  applied  to  every  punctured  wound. 

In  those  regions  where  poisonous  snakes  exist,  bites  from 
them  may  occur.  Until  the  physician  arrives,  girdle  tightly 
the  bitten  limb  above  the  wound,  squeeze  out  all  the  blood 
possible  from  the  latter,  and  lay  on  an  antiseptic  dressing. 

BRUISES   AND   BUMPS 

Bruises  and  bumps  are  among  the  commonest  injuries  of 
childhood.  If  the  skin  upon  the  bruised  place  is  broken,  the 
injury  is  converted  into  a  lacerated  wound,  and  is  to  be 
treated  according  to  the  general  rules  already  given.  If  the 
skin  is  not  broken,  the  treatment  is  directed  to  the  diminution 
or  prevention  of  the  pain  and  swelling,  as  Avell  as  the  subse- 
quent discoloration  due  to  the  effusion  of  blood  beneath  the 
skin.  The  applications  may  be  hot  or  cold,  but  they  should 
not  be  alternately  both  nor  half-way.  If  hot  water,  which  is 
preferable,  is  used,  persist  wdth  it.  If  hot  w^ater  is  not  at 
hand  or  easily  had,  stick  to  cold  water.  The  effect  of  either  is 
increased  by  making  some  pressure  with  the  cloth  by  which 
the  hot  or  cold  water  is  applied.  A  bump  on  the  head  may 
be  attended  with  concussion  of  the  brain,  or  stunning,  which 
for  the  moment  takes  precedence  of  the  bump  itself  in  atten- 
tion. The  child  in  this  case  should  be  allowed  to  lie  quiet. 
If  the  surface  is  cold,  hot  bottles  or  other  sources  of  heat 
should  be  put  about  him.  It  is  unwise  to  give  alcoholic  stim- 
ulants in  any  amount,  as  they  increase  the  subsequent  head- 
ache. Ammonia  is  better.  Vomiting  generally  announces 
the  commencement  of  the  rallying. 

Besides  the  w^ater  applications  spoken  of,  alcohol  and  water, 
wdtch-hazel  extract,  and  a  variety  of  well-known  things  are 
in  common  use.  It  is,  however,  doubtful  whether  they 
have  any  advantage  whatever  over  the  simple  w^ater  com- 
presses. 


NURSERY  EMERGENCIES  173 


SPRAINS 

Sprains  are  wrenchings  of  the  soft  parts  about  a  joint 
without  injury  to  the  bony  parts.  They  vary  greatly  in 
degree.  It  is  very  important  to  be  sure  that  the  bones  have 
escaped  injury.  Therefore  a  sprain  of  any  considerable  se- 
verity needs  an  examination,  at  least,  by  a  physician.  For 
milder  sprains,  in  which  there  is  no  question  of  a  break,  the 
most  successful  treatment  consists  in  putting  the  injured 
joint,  if  practicable,  into  water  as  hot  as  can  be  borne,  the 
heat  being  kept  up  by  additions  of  hot  water.  If  this  can- 
not be  done,  an  ice-bag  may  be  applied.  After  the  joint  is 
thus  made  comfortable,  it  may  be  made  firm  by  the  appli- 
cation of  strips  of  adhesive  plaster,  when  the  use  of  the  limb 
may  be  resumed.  This  plan  of  treatment  is  most  applic- 
able to  sprains  of  the  ankle.  If  there  is  reason  to  suspect  a 
fracture,  the  injured  part  is  to  be  put  into  as  comfortable 
a  position  as  possible  and  supported  there  until  the  physician 
can  see  it. 


BURNS  AND  SCALDS 

Burns  and  scalds  differ  only  in  their  causation,  the  one 
being  caused  by  dry  heat,  the  other  by  hot  liquids.  Severe 
and  extensive  burns  are  among  the  gravest  of  injuries. 
Slight  ones  can  be  treated  by  putting  upon  the  surface  bi- 
carbonate of  soda  either  dry  or  in  solution,  or  a  solution  of 
carbolic  acid  in  water,  a  teaspoonful  of  the  former  to  a  pint 
of  the  latter.  As  the  carbolic  acid  does  not  always  dissolve 
perfectly  without  waiting,  it  is  well  to  have  the  solution 
on  hand,  as  it  is  useful  for  almost  all  antiseptic  washes,  as 
well  as  for  burns.  Oils  are  also  useful  to  cover  the  sur- 
face, and  the  mixture  of  linseed-oil  and  lime-water,  known 
as  carron  oil,  while  not  very  elegant,  is  very  useful.  What- 
ever is  used  for  the  application,  the  surface  is  to  be  pro- 
tected from  the  air  by  a  covering  of  cotton,  gauze,  or 
linen. 


174  THE  CENTURY  BOOK  FOR  MOTHERS 


CAUTIONS  AS  TO   FIRE 

It  is  well  to  know  and  to  teach  servants  and  older  children 
how  to  manage  a  child  whose  clothing  has  caught  fire.  It 
must  not  be  allowed  to  run  about.  It  should  be  thrown 
down,  or  throw  itself  dow^n,  to  keep  tlie  flames  from  the  face, 
and  be  wrapped  in  any  heavy  woolen  thing  at  hand— rug, 
blanket,  heavy  woolen  garment,  or  what  not.  When  the  fire 
is  extinguished,  the  clothing  should  be  taken  off  carefully, 
cutting  it  away  from  the  burned  parts  to  avoid  additional 
injuries  to  these  last.  Stimulants,  such  as  wine,  spirits, 
coffee,  or  tea,  may  be  called  for  if  there  is  great  shock. 


FROST-BITE  AND  CHILBLAINS 

Quite  the  opposite  as  to  cause  are  frost-bite  and  chilblains. 
The  frost-bites  in  children  are  usually  of  especially  exposed 
parts,  such  as  the  ears,  tip  of  the  nose,  and  sometimes  of  fin- 
gers and  toes.  If  after  or  during  exposure  to  great  cold  any 
of  these  parts  be  noticed  to  be  abnormally  white,  freezing 
may  be  suspected.  The  circulation  should  be  stimulated  by 
friction,  while  a  sudden  change  of  temperature  is  avoided. 
A  favorite  method  of  stimulation  is  to  rub  the  affected  parts 
with  snow.  Indoors,  applications  of  ice-cold  water  may  be 
made  before  the  sufferer  enters  a  warm  room.  The  chilblain  is 
an  incomplete  frost-bite  of  a  part  which  has  not  been  guarded 
against  a  sudden  change  of  temperature,  the  minute  blood- 
vessels having  lost  their  tone  from  violent  change.  Chilblains 
may  sometimes  be  prevented  or  mitigated  by  the  same  ap- 
plications as  are  recommended  for  frost-bite.  In  strong, 
healthy  children  chilblains  are  distressing  from  their  burn- 
ing and  itching;  in  feeble  children  they  may  even  be  a 
serious  malady.  The  care  of  them,  if  they  have  been  estab- 
lished, consists  in  keeping  the  feet  dry,  in  wearing  spacious 
shoes,  besides  sometimes  making  soothing  applications.  The 
itching  sometimes  jdelds  to  alkaline  baths,  sometimes  to  sim- 
ple cold  foot-baths.     For  the  feeble,  tonics  are  necessary. 


NURSERY  EMERGENCIES  175 

REMOVAL  OF   FOREIGN   BODIES 

A  COMMON  mischance  of  the  nursery  is  a  foreign  body  in 
the  eye,  in  the  ear,  nose,  or  somewhere  in  the  alimentary 
canal.  Only  rarely  does  one  get  into  the  air-passage.  With 
the  exception  of  things  in  the  eye,  all  these  accidents  are  the 
result  of  the  child's  own  meddlesome  habit  of  tucking  away 
things.  In  the  eye  may  be  lodged  cinders,  dust,  small  par- 
ticles of  any  kind,  as  well  as  loosened  eyelashes.  Any  of 
them  may  give  a  good  deal  of  discomfort,  or  even  suffering, 
if  allowed  to  remain.  A  convenient  instrument  for  the  re- 
moval of  such  a  body  can  be  made  by  winding  a  bit  of  ab- 
sorbent cotton  about  the  end  of  a  wooden  toothpick  or  a 
similar  bit  of  wood  or  a  tape-needle.  When  it  is  ready,  look 
at  the  eye  to  see  if  the  object  to  be  recovered  is  in  sight. 
If  so,  it  can  be  quickly  wiped  away  with  the  swab  just 
made  with  a  sidewise  motion,  the  child's  head  being  firmly 
held  meantime.  If  it  is  not  in  sight,  depress  the  lower  lid 
and  search.  If  this  fails,  the  upper  lid  must  be  searched, 
and  perhaps  turned  over.  This  is  done  thus:  First,  the 
upper  lid  is  seized  by  its  margin  and  the  lashes  and  drawn 
down  over  the  lower  lid.  The  motions  of  the  eye,  involun- 
tary or,  in  the  case  of  an  older  child,  voluntary,  may  dislodge 
the  object,  so  that  it  will  be  found  on  the  outside  of  the  lower 
lid  when  the  upper  one  is  released.  If  this  fails,  seize  the 
upper  lid  as  before,  lay  upon  its  outer  surface  some  small 
cylindrical  thing,  such  as  the  small  end  of  a  penholder,  hold 
it  firmly,  and  turn  the  lid  up  over  it.  Examine  the  exposed 
inner  surface,  and  if  the  object  is  found,  wipe  it  off  as  before 
described.  Small  fragments  of  steel  often  lodge  themselves 
too  firmly  for  removal  by  these  gentle  measures,  and  a  physi- 
cian's  skill  and  appliances  are  needed.  If  an  eye  is  wounded, 
only  cold  applications  are  permissible  until  the  physician 
comes. 

Substances  in  the  nose  may  be  expelled  by  nose-blowing 
or  by  sneezing  if  excited  by  tickling  or  otherwise.  Clumsy 
manipulation  sometimes  wedges  them  in  more  firmly  than 


176       THE  CENTURY  BOOK  FOR  MOTHERS 

before.  Therefore,  before  endeavoring  to  remove  a  foreign 
body  examine  to  see  if  it  can  be  easily  gotten  at,  and,  if  so, 
whether  you  have  a  suitable  extractor.  The  bent,  round  end 
of  a  hairpin  can  often  be  made  into  a  successful  implement. 
In  the  majority  of  cases  it  is  safer  to  leave  the  case  to  the 
physician. 

The  same  caution  applies  to  things  introduced  into  the 
ear.  Often  the  difficulty  which  the  physician  experiences  in 
removing  a  foreign  body  is  largely  due  to  previous  unskilful 
attempts.  If  the  body  does  not  fall  out  when  the  child  is 
laid  w^th  that  ear  down,  or  if  it  does  not  come  out  with 
gentle  syringing,  domestic  attempts  would  better  stop.  Lit- 
tle harm  can  arise  from  its  temporary  stay  in  the  ear- 
passage. 

Foreign  bodies  in  the  throat— that  is  to  say,  in  the  pharynx 
—may  sometimes  be  dislodged  by  inverting  the  child  and 
giving  it  a  smart  blow  on  the  shoulders.  Sometimes  the 
bodies  are  sufficiently  visible  to  be  extracted  by  the  finger 
while  the  child  is  inverted.  If  the  body  has  been  swallowed, 
— i.  e.,  has  gone  into  the  stomach— the  most  advisable  plan, 
if  the  child  be  old  enough  to  take  such  articles  with  safety, 
is  to  give  it  bulky  food,  such  as  potato  or  bread,  the  body 
being  usually  carried  through  the  alimentary  canal  with 
them  and  being  found  in  the  faeces. 


NOSEBLEED 

Various  causes  combine  to  make  nosebleed  a  common  oc- 
currence. It  is  in  later  childhood  that  it  occurs,  rather  than 
in  infancy,  and  in  childhood  it  is  rarely  alarming  in  extent. 
Among  the  common,  as  well  as  the  most  useful,  domestic  reme- 
dies are  quiet,  recumbency  with  head  raised,  cold  to  the 
back  of  the  neck  or  to  the  root  of  the  nose  between  the  eyes, 
pressure  on  the  nose  at  that  point,  pressure  upon  the  upper 
lip,  and  the  raising  of  the  arms  high  above  the  head.  If  the 
bleeding  be  from  a  blow  upon  the  nose,  pains  should  be 
taken  to  make  sure  that  this  organ  is  not  broken.     It  is  sur- 


NURSERY  EMERGENCIES  177 

prising  how  frequently  such  injuries  are  not  recognized  until 
deformity  has  occurred. 


RESUSCITATION    IN   DROWNING  ACCIDENTS 

Drowning  is  fortunately  a  rare  accident,  but  when  it  does 
occur  the  efforts  at  resuscitation  must  be  immediate.  The 
efforts  of  a  bystander  applied  at  once  may  succeed.  No 
effort,  even  the  most  skilful,  can  avail  after  much  delay. 
Therefore,  as  soon  as  the  body  is  taken  from  the  water  to  a 
place  of  safety,  work  should  be  begun.  For  popular  use, 
a  method  of  resuscitation  needs  to  be  not  only  efficient  but 
simple.  To  the  writer,  the  method  of  Dr.  Satterthwaite 
seems,  on  the  whole,  to  unite  these  qualities.  It  is  briefly 
described  below. 

1.  While  one  is  at  work  upon  the  drowned  person,  others, 
if  present,  should  endeavor  to  get  dry  covers  and  clothing— 
their  own  will  do— and  hot  water,  or  make  a  fire  by  the 
water-side  to  heat  articles.  If  nothing  else  can  be  had,  the 
stones  upon  the  beach  can  be  heated. 

2.  The  operator  first  endeavors  to  empty  the  water  from 
the  patient.  "To  do  this  effectively,  roll  the  person  over 
on  the  face,  which  should  be  a  little  lower  than  the  body ; 
if  the  bank  be  shelving,  let  the  heels  be  higher  than  the 
head ;  then  wedge  open  the  mouth  and  keep  it  open  by  a  bit 
of  wood  or  by  a  knot  in  a  handkerchief.  The  tongue  should 
also  be  depressed.  Then,  getting  astride  of  the  person,  press 
with  the  flat  of  the  hand  upon  the  abdomen,  so  as  to  push 
up  the  diaphragm.  In  half  a  minute,  or  probably  less,  the 
water  will  be  driven  out  sufficiently  to  allow  efforts  at  arti- 
ficial respiration  to  be  made. 

3.  "Then  turn  the  person  on  to  the  back,  place  him  in  a 
horizontal  position,  keeping  the  mouth  wedged  open  as  be- 
fore and  the  finger  on  the  back  of  the  tongue,  and  make  pres- 
sure again  with  the  hand  upon  the  abdomen,  so  as  to  press 
the  diaphragm  upward.  Make  pressure  slowly  at  first,  and 
then  force  the  air  out.     Then  withdraw  the  hand,  that  the 

12 


178       THE  CENTURY  BOOK  FOR  MOTHERS 

diaphragm  may  fall  and  the  lungs  inflate  with  air.  .  .  . 
At  first  make  three  or  four  movements  in  a  minute,  then  in- 
crease to  ten  or  fifteen,  and  persevere  at  that  rate  until  there 
are  evidences  of  returning  respiration  or  it  is  plain  that  life 
is  extinct." 

This  plan  permits  the  simultaneous  use  of  the  Sylvester 
method,  if  one  familiar  with  it  be  present,  but  for  those  un- 
used to  such  emergencies  complicated  methods  are  apt  to 
defeat  themselves.  Rubbing  the  person,  giving  ammonia  to 
smell,  and,  above  all,  the  use  of  hot  applications— hot  water 
if  it  can  be  had— at  as  great  a  heat  as  the  hand  will  bear,  are 
valuable.  If  the  patient  revives,  he  is  to  be  taken  to  a  quiet 
place,  where  hot  broths,  beef-tea,  hot  tea  or  coffee,  or  alco- 
holic drinks  in  moderation  may  be  given. 

CONVULSIONS 

Probably  the  most  alarming  emergency  in  the  nursery  not 
due  to  an  accident  is  the  occurrence  of  convulsions.  The 
causes  of  these  are  manifold,  and  the  management  of  them 
beyond  the  range  of  domestic  medicine.  The  drugs  most 
relied  upon  by  physicians,  such  as  chloroform,  its  relative, 
chloral,  and  morphia,  are  not  to  be  used  without  knowledge. 
If  a  physician  can  possibly  be  had,  he  should,  of  course,  at 
once  be  sent  for.  AVhile  he  is  coming,  the  parent  should 
endeavor  not  to  do  harm.  The  child  should  be  kept  as  quiet 
as  possible.  The  bed  should  be  covered  with  a  layer  or  two 
of  blanket,  and  the  child,  undressed  with  the  least  possible 
disturbance,  be  laid  upon  it.  Then  he  should  be  enveloped 
in  a  mustard  pack,  or,  if  the  mustard  be  not  at  hand,  in  a 
simple  hot  pack.  This  is  given  by  wringing  out  a  sheet  in 
hot  water  and  applying  it  quickly  all  over  the  child.  For  the 
mustard  pack,  the  mustard  is  added  to  the  hot  water  before 
the  sheet  is  dipped.  The  usual  strength  is  a  tablespoonful 
of  mustard  to  a  quart  of  hot  water.  A  smaller  amount  of 
mustard  will  often  suffice.  When  the  skin  is  decidedly  red, 
the  pack  may  be  removed.     This  will  usually  occur  in  ten 


NURSERY  EMERGENCIES  179 

minutes.  It  must  be  watched,  as  the  child  can  give  no  warn- 
ing, and  the  sensibility  of  the  skin  varies;  a  mustard  burn 
is  an  ugly  thing  to  heal. 

In  the  rare  instances  where  no  physician  can  be  reached, 
in  the  absence  of  definite  knowledge  of  the  cause  of  the  con- 
vulsion, it  is  fairly  safe  to  assume  that  some  digestive  de- 
rangement is  at  fault.  The  bowels  may  be  cleared  out  by 
a  full  enema  or  by  irrigation,  and  if  there  is  reason  to  sup- 
pose that  food  is  still  in  the  stomach  itself,  an  emetic  of  the 
syrup  or  the  wine  of  ipecac  may  be  given.  After  the  sub- 
sidence of  the  convulsions  the  child  is  to  be  kept  quiet,  and 
its  nervous  system  still  further  soothed  by  the  use  of  bro- 
mides for  a  few  days.  But  it  is  to  be  always  remembered 
that  next  to  the  quieting  of  the  attack  of  convulsion,  the 
recognition  of  the  cause  of  it  and  the  prevention  of  repeti- 
tions is  the  important  matter. 

ACCIDENTS   DUE  TO   POISON 

Accidental  poisoning  in  the  nursery  is  rare.  If  poisons 
are  properly  kept,  or  still  more  properly  excluded,  there  is 
very  little  possibility  of  accident.  Whenever  it  is  thought 
necessary  to  have  in  the  house  a  poisonous  remedy,  it  should 
be  kept  safely  out  of  reach  of  children,  and  if  it  be,  as  is 
the  pharmaceutical  rule,  put  in  a  colored  or  marked  bottle 
and  a  memorandum  of  the  antidote  gummed  to  it,  there  is 
little  chance  of  a  mishap.  Most  such  accidents  as  do  occur 
are  due  to  articles  not  medicinal,  which  are  left  about  or 
allowed  to  fall  where  a  child  may  get  them;  such,  for  in- 
stance, are  match-heads,  causing  phosphorus  poisoning;  ox- 
alic acid,  used  to  clean  boilers  and  copper  work ;  in  the  coun- 
try, Paris  green  (aceto-arsenite  of  copper),  used  to  kill 
insects. 

In  the  first  place,  it  should  be  said  that  for  every  poison 
which  has  been  swallowed  an  emetic  is  proper,  although  for 
the  removal  of  some  of  them  it  may  not  be  very  efficient, 
owing  to  the  blunting  of  the  sensibility  of  the  stomach.     In 


180       THE  CENTURY  BOOK  FOR  MOTHERS 

any  case,  therefore,  it  should  be  tried.  The  emetic  should 
be  one  of  prompt  action.  Therefore,  mustard  and  water, 
and  strong  soap-suds  (laundry  soap  preferred)  are  among 
the  best  emetics. 

If  the  substance  swallowed  be  an  acid,  it  should  be  neu- 
tralized by  an  alkali.  Here,  again,  suds  from  coarse  soap 
is  available  and  efficient  as  an  alkali,  as  well  as  an  emetic. 
Lime-water  may  be  in  the  house,  and  can  be  used.  So  may 
chalk,  the  refined  chalk  known  as  whiting  used  for  polish- 
ing silver,  or  magnesia.  For  oxalic  acid,  lime-water  or  chalk 
is  best. 

If  an  alkali  (potash,  soda,  lime,  or  ammonia  in  some  irri- 
tating form)  be  swallowed,  an  acid  is  called  for.  Vinegar 
and  lemon-juice  are  those  most  likely  to  be  at  hand. 

Carbolic  acid  deserves  especial  mention,  as  it  is  an  acid 
only  in  name.  The  best  antidote  is  thought  to  be  one  of 
the  alkaline  sulphates,  such  as  Epsom  salts  or  Glauber's  salts, 
both  in  use  as  cathartics.  The  Epsom  salt  is  the  more  likely 
to  be  in  the  house.  Give  it  freely  and  promptly.  Creosote 
is  comparatively  little  used  nowadays,  but  poisoning  from  it 
is  to  be  treated  as  if  from  carbolic  acid. 

After  the  emetic  and  the  antidote  have  been  given,  it  is 
proper,  if  the  poison  is  of  an  irritant  nature,  to  give  milk 
or  white  of  an  egg,  oil,  and  soothing  drinks.  This  is  espe- 
cially true  of  irritating  metallic  salts,  such  as  antimony  (tar- 
tar emetic),  arsenic  (Paris  green),  verdigris  or  blue  vitriol 
(both  copper  salts),  corrosive  sublimate  (mercuric  bichlorid), 
sugar  of  lead.  But  the  exception  of  phosphorus  must  be 
borne  in  mind,  because  any  oil  renders  phosphorus  more 
soluble  and  more  poisonous. 

Phosphorus  poisoning  is  most  likely  to  come  from  matches. 
A  child  may  get  a  package  and  suck  off  the  highly  colored 
heads.  The  desirable  emetic  in  this  case  is  the  sulphate  of  cop- 
per (blue  vitriol),  since  it  is  not  only  an  emetic,  but  the  anti- 
dote as  well.  It  may  be  repeated  after  vomiting  has  occurred. 
If  time  has  elapsed  for  some  of  the  poison  to  have  passed  into 
the  bowels,  they  should  be  cleared  with  Epsom  salts. 


NURSERY  EMERGENCIES  181 

For  any  poison  causing  great  depression,  such  as  aconite, 
chloral,  antipyrine,  or  phenacetin,  stimulants,  like  alcoholic 
liquors,  coffee  or  tea,  and  heat,  are  proper. 

For  poisoning  from  any  preparation  of  opium  (morphine, 
laudanum,  paregoric,  etc.),  the  prime  things  after  the  emetic 
are  to  give  coft'ee  and  to  keep  the  patient  awake  by  motion 
or  in  any  other  way.  The  physician  will  have  additional 
resources. 

Occasionally  a  case  of  poisoning  occurs  in  the  country 
from  the  eating  of  some  part  of  one  of  the  plants  of  the 
solanaceffi,  the  stramonium  or  jimson  weed,  the  tobacco  plant, 
the  belladonna,  or  deadly  nightshade,  the  last  found  in  gar- 
dens but  not  a  native  plant.  To  these  may  be  added  some  poi- 
sonous mushrooms,  especially  the  poisonous  species  of  amanita. 
The  stomach  must  be  emptied  at  once,  and  the  bowels  soon 
after.  In  the  case  of  all  these  plants  the  poison  is  rendered 
insoluble,  and  therefore  less  active,  by  tannic  acid  or  tannin, 
which  is  sometimes  in  the  house.  If  in  no  better  form,  it  can 
be  found  in  a  strong  decoction  of  tea.  The  agreeable  infusion 
made  by  skilful  tea-makers  is  not  so  useful  for  this  purpose 
as  the  decoction  which  the  cook  keeps  stewing  all  day  on  the 
corner  of  the  stove,  since  the  latter  contains  all  the  tannic 
acid  which  can  be  extracted  from  the  leaves. 

Of  course,  whatever  the  poison,  medical  aid  should  be  sum- 
moned if  possible. 


XIY 
THE  HOUSEHOLD  PHARMACY 

IN  the  previous  chapters  various  medicines  or  remedies 
have  been  mentioned.  It  may  be  helpful  to  enumerate 
them  again  and  to  make  a  few  suggestions  as  to  their  uses. 
It  should  first  be  said  that  if  medicines  are  to  be  kept  at  all  in 
the  house,  they  should  be  together  in  a  place  provided  for 
them  and  be  always  in  order.  For  the  purpose,  a  little  cup- 
board is  convenient,  such  as  sold  in  furniture  shops  for 
the  purpose.  But  a  costly  one  is  by  no  means  necessary, 
and  a  little  ingenuity  will  make  a  very  convenient  one  from 
an  ordinary  box  if  nothing  better  is  at  hand.  In  the  writ- 
er's opinion,  it  is  far  better  to  have  a  cupboard  of  this 
rude  sort  than  to  allow  medicines  to  stand  about  on  mantels, 
bureaus,  on  closet  shelves,  or  in  drawers  mixed  up  \^dth  other 
things.  Such  want  of  system  invites  accident,  and  in  emer- 
gencies often  defeats  the  best  intentions.  The  medicine  cup- 
board should  be  in  as  cool  a  place  as  possible,  and  it  should 
have  a  door  or  curtain,  as  many  remedies  keep  better  away 
from  the  light. 

CONVENIENCES 

Among  the  conveniences  of  this  cupboard  are  measuring- 
glasses.  Spoons  have  been  used  for  generations  as  measures, 
and  they  do  very  well,  but  they  vary  somewhat  in  size,  and 
different  persons  fill  them  more  differently.  Glasses  marked 
by  teaspoonfuls  and  tablespoonfuls  are  for  sale,  and  the 
druggist's  graduate  glass  is  still  more  accurate.  The  latter 
is  now  sold  not  only  by  druggists,  but  by  dealers  in  photo- 

182 


THE  HOUSEHOLD  PHARMACY  183 

graphic  goods  at  very  moderate  prices.  Still  more  useful  is 
a  little  graduated  glass  to  measure  minims.  These  save  the 
trouble  of  counting  and  are  more  accurate,  since  the  minim 
is  a  fixed  measure  and  is  usually  meant  when  a  dose  is 
stated  in  ''drops,"  while  the  actual  drop  varies  in  size  with 
the  liquid  and  the  orifice  from  which  it  is  dropped.  If  such 
a  measuring-glass  cannot  be  obtained  it  is  well  to  obtain 
from  the  pharmacist  a  medicine-dropper,  which  he  finds 
delivers  minims  pretty  accurately.  In  using  it,  the  point 
is  immersed  in  the  liquid,  the  bulb  compressed  to  expel  the 
air,  and  when  the  pressure  is  released  some  of  the  liquid 
rises  into  the  tube,  whence  it  can  be  slowly  pressed  out,  drop 
by  drop.  For  putting  liquids  into  the  eye  the  droppers  hav- 
ing a  much  finer  outlet  and  giving  small  drops  are  com- 
monly preferred.  Whatever  measure  is  used,  always  cleanse 
it  thoroughly  before  it  is  put  aAvay. 

The  fever  thermometer,  if  one  is  owned,  should  be  kept 
with  remedies. 

Most  households  possess  an  ordinary  bag  or  "fountain" 
syringe.  Having  various  nozzles,  most  things  may  be  done 
with  it.  Scald  the  nozzle  selected  before  using,  as  contagious 
ailments  are  sometimes  communicated  by  reason  of  persons 
making  unauthorized  use  of  another  person's  syringe. 

Besides  the  bag  syringe,  a  hard-rubber  piston  syringe,  to 
hold  six  ounces,  is  useful  in  the  nursery.  Better  yet,  per- 
haps, is  the  ordinary  bulb  syringe,  with  a  soft-rubber  nozzle. 
The  latter  can  be  easily  made  extemporaneously  from  a  piece 
of  small  rubber  tubing  slipped  over  the  hard  nozzle.  For 
high  enemas,  a  soft-rubber  catheter  is  used,  but  as  it  is  likely 
to  spoil  if  kept  without  using  it  would  better  be  bought  when 
required. 

FOR   SURGICAL   NEEDS 

For  the  surgical  emergencies  described,  the  following  things 
are  convenient: 

A  pair  of  tweezers,  preferably  strong  enough  to  hold 
tightly  to  whatever  they  may  grasp,  also  with  rather  fine 


184  THE  CENTURY  BOOK  FOR  MOTHERS 

points,  so  that  they  may  grasp  splinters  under  the  nails  or 
other  things  in  cramped  situations. 

Absorbent  cotton. 

Gauze  or  old  linen. 

These  articles  should  be  done  up  into  small  packages,  so 
that  they  may  be  kept  clean  until  required.  They  may  be 
bought  in  such  parcels.  Gauze  can  be  easily  and  cheaply 
made  from  cheese-cloth,  which  is  boiled  and  dried,  cut  up  into 
yard  lengths  and  then  folded  into  bundles  which  will  go  into 
an  ordinary  preserving- jar.  Put  each  piece  into  a  jar  with 
the  cover  loosely  on,  place  it  in  a  slow  oven  and  heat,  stop- 
ping if  signs  of  browning  appear.  Fasten  the  cover  of  the 
jar,  and  the  gauze  will  be  clean  until  used.  Cotton  or  old 
linen  may  be  made  sterile  in  the  same  way. 

Bandages  may  be  made  of  gauze,  linen,  or  cotton;  the 
first  is  cheapest  and  best.  They  may  be  bought,  if  preferred. 
They  should  be  of  different  widths,  from  one  inch  wide  for 
children's  hands  to  two  and  one  half  inches  for  their  limbs. 
For  adults,  still  wider  ones  are  used.  They  should  be  rolled 
up  firmly  into  cylinders.  The  lengths  for  the  nursery  should 
be  from  one  to  two  yards. 

For  adjusting  wounds  nicely  isinglass  plaster  is  best.  It 
adheres  by  moistening.  Never  w^et  the  plaster  for  a  wound 
in  the  mouth.  Take  a  small  wad  of  absorbent  cotton  or 
gauze,  wring  it  out  of  boiled  water  or  boiled  water  contain- 
ing salt  or  some  other  antiseptic.  Moisten  the  plaster  with 
this  wad. 

AVhen  a  more  retentive  dressing  is  needed,  the  rubber  plas- 
ter now  so  generally  sold  on  spools  is  most  convenient.  It 
adheres  without  warming.  Half  an  inch  is  a  convenient 
width  for  nursery  use.  A  similar  plaster,  containing  zinc 
oxide,  is  in  use  for  irritable  skins. 

The  wads  of  cotton  or  gauze  just  alluded  to  have  displaced 
sponges  for  cleansing  wounds  in  domestic  surgery.  They 
are  more  certain  to  be  clean,  and  are  thrown  aside  as  used. 

A  one-ounce  vial  of  collodion,  with  a  camel 's-hair  brush 
fixed  in  the  stopper,  is  very  convenient  for  covering  scratches, 


THE  HOUSEHOLD  PHARMACY  185 

etc.,  after  they  have  been  cleansed.  A  finger  should  be  kept 
over  the  mouth  of  the  vial  whenever  the  stopper  is  out,  as 
the  ether  of  the  collodion  rapidly  evaporates  and  leaves  a 
hard  unmanageable  mass  behind. 

Vaseline  or  cosmoline  has  become  a  household  convenience. 
For  the  dressing  of  wounds,  it  is  best  bought  in  tubes  with 
screw  caps,  like  an  artist's  colors,  as  that  not  used  is  thus 
more  readily  kept  clean.  When  needed  the  vaseline  is 
squeezed  out. 

DISINFECTANTS 

It  is  doubtful  if  the  more  poisonous  antiseptics  should  be 
kept  in  the  house,  except  during  the  time  of  their  constant 
use.  Boric  acid,  used  in  the  form  of  a  saturated  solution, 
alcohol,  and  a  solution  of  common  salt  in  boiled  water,  a 
heaping  teaspoonful  to  a  pint,  serve  for  most  nursery  sur- 
gery. The  boric  acid  should  be  plainly  marked,  as  it  is  some- 
times mistaken  for  milk-sugar.  But  this  rule  of  plain  label- 
ing must  be  applied  to  every  remedy. 

Oiled  silk  or  thin  rubber  is  convenient  for  covering  dress- 
ings of  all  sorts.  If  these  are  used  and  it  be  desired  to 
keep  them  for  further  use,  they  must  be  placed  in  boiling 
water  for  disinfection  before  they  are  put  away. 

Whenever  an  instrument  or  a  basin  is  to  be  used,  it  should 
be  made  clean  by  heat.  Instruments  of  steel  are  to  be  boiled, 
a  little  bicarbonate  of  soda  being  put  into  the  water  to  pre- 
vent rusting.  An  agate  or  metal  basin  can  be  exposed  to  a 
still  higher  heat  than  that  of  an  oven,  as  it  has  no  temper  to 
be  considered,  as  has  the  steel  instrument. 

MEDICINES 

The  medicines  to  be  kept  in  the  nursery  pharmacy  need 
not  be  many.  To  begin  with,  a  good  many  of  them  are 
found  in  the  kitchen  or  pantry,  and  may  as  well  remain  there 
until  needed.  Thus,  alcohol  is  often  in  use  for  the  spirit 
lamp.     Whisky  or  some  similar  stimulant  is  more  likely  to 


186       THE  CENTURY  BOOK  FOR  MOTHERS 

be  in  the  house  than  is  necessary.  The  coarse  preparations 
of  ammonia  now  very  generally  used  in  the  household  will 
serve  perfectly  well  as  a  stimulant  to  the  nostrils,  but  not 
for  internal  use. 

Bicarhonate  of  soda  (baking  soda)  is  pretty  certain  to  be 
in  the  kitchen.  It  is  useful  as  an  application  to  burns  and 
as  an  antidote  to  acids  swallowed. 

Olive  oil  is  useful  as  an  external  application,  especially 
for  burns,  as  a  lubricant,  as  an  ingredient  of  enemas,  and 
as  a  remedy,  after  vomiting  has  been  produced,  for  almost 
all  poisoning  from  irritating  substances. 

Salt  and  mustard  are  among  the  best  of  prompt  emetics. 
The  salt  may  be  dissolved  in  water  in  almost  any  proportion. 
It  also,  if  added  to  an  enema,  increases  its  activity.  Its  use 
as  a  disinfectant  has  just  been  described.  Mustard  as  an 
emetic  is  very  prompt.  An  adult  may  take  a  tablespoonful 
of  dry  mustard,  if  mixed  with  an  equal  amount  of  molasses 
and  a  glass  of  water.  The  object  of  the  molasses  is  to  insure 
complete  mixture.  In  the  nursery,  a  teaspoonful  would  be 
enough.     Soap-suds  also  furnish  a  useful  emetic. 

Meal  of  any  sort  will  furnish  poultice  material  in  an  emer- 
gency. Turpentine,  useful  for  stupes  (see  p.  156),  is  usually 
kept  for  cleaning. 

This  considerable  number  of  remedies  being  found  among 
the  household  articles  proportionately  diminishes  the  number 
which  need  be  kept  in  the  medicine-closet. 

The  list  of  medicines  which  may  be  used  is  a  long  one,  but  a 
very  short  one  will  contain  all  the  drugs  that  would  better 
be  in  a  family  medicine-closet.  INIedicines  recommended  by  a 
physician  for  a  particular  child  or  for  members  of  the  fam- 
ily for  whom  they  are  suitable  may  be  added  from  time  to 
time,  but  should  be  labeled  and  kept  track  of  by  some  method, 
as  suggested  on  page  179. 

For  general  use  in  emergencies,  there  may  be  kept  as 
cathartics  castor-oil  and  triturates  of  calomel.  The  advan- 
tages of  each,  the  methods  of  keeping  and  of  administration, 
are  mentioned  on  pages  159  and  165. 


THE  HOUSEHOLD  PHARMACY  187 


EMETICS 


For  general  use,  the  syrup  of  ipecac  is  best.  It  is  safe,  as 
it  produces  no  harmful  effects  beyond  the  vomiting.  It  is 
especially  applicable  when,  as  in  spasmodic  croup,  it  is  de- 
sired to  produce  a  certain  amount  of  relaxation  from  the 
preliminary  nausea.  The  dose  is  from  half  a  teaspoonful  to 
a  teaspoonful,  according  to  the  age  of  the  child,  repeated  in 
twenty  minutes  if  it  has  not  sooner  acted.  For  immediate 
production  of  vomiting,  without  nausea,  mustard  has  already 
been  recommended.  Poivdered  alum  acts  in  the  same  man- 
ner. The  dose  is  usually  about  a  level  teaspoonful  mixed 
with  syrup.  Another  use  of  the  syrup  of  ipecac  is  as  an 
expectorant— that  is  to  say,  to  "loosen"  the  cough  of  laryn- 
gitis and  bronchitis.  The  syrup  can  be  mixed  with  water  in 
such  proportions  that  a  teaspoonful  of  the  mixture  shall  con- 
tain one  or  two  drops  of  the  syrup.  This  may  be  given  by 
the  teaspoonful  every  half  hour,  but  the  dosing  must  be 
stopped  if  nausea  is  manifested  or  if  the  symptoms  are  re- 
lieved. 

CARMINATIVES 

Carminatives  are  useful  for  the  relief  of  colic.  The  most 
efficient  and  agreeable  are  the  spirit  of  peppermint  or  of 
anise.  Fifteen  or  tw^enty  drops  may  be  added  to  a  tea- 
cupful  of  hot  water,  and  the  well-stirred  mixture  adminis- 
tered by  spoonfuls  to  an  infant.  An  older  child  may  drink 
as  much  as  it  pleases  from  the  cup.  For  colic  due  to  acidity, 
an  antacid  is  often  useful.  This  is  one  of  the  uses  of  lime- 
water.  Another  useful  antacid  is  the  bicarbonate  of  soda. 
This  compressed  into  tablet  form,  with  the  addition  of  pep- 
permint, constitutes  the  soda-mints  of  the  shops.  They  are 
quite  convenient  for  ordinary  emergencies.  If  they  are  to 
be  used  they  should  be  bought  fresh— i.  e.,  with  a  strong 
odor  of  peppermint— and  kept  in  a  tightly  corked,  wide- 
mouthed  vial. 


188       THE  CENTURY  BOOK  FOR  MOTHERS 

REMEDIES  FOR  FEVER 

For  the  relief  of  fever,  the  writer  believes  that  the  time- 
honored  sweet  spirits  of  nitre  is  safer  and  better  for  house- 
hold use  than  any  other  remedy.  It  has  no  depressing 
after-effects,  such  as  make  aconite  and  the  popular  coal-oil  de- 
rivatives so  unfit  for  domestic  use.  Besides  promoting  per- 
spiration, it  calms  nervous  irritation  and  excites  a  flow  of 
urine.  For  this  last  reason,  it  is  much  used  when  this  excre- 
tion is  scanty.  The  dose  for  a  child  would  be  five  to  ten 
drops,  according  to  age,  repeated  hourly.  A  convenient  way 
is  to  put  half  a  teaspoonful  or  more  into  a  glass  of  cool  water 
and  let  the  child,  if  above  two  years  of  age,  drink  from 
this  glass,  using  the  whole,  if  he  chooses,  in  the  course  of 
two  hours.  Keep  the  mixture  covered  in  the  intervals  of 
drinking.  The  medicine  itself  should  be  kept  in  a  small 
vial,  as  nearly  full  as  convenient,  tightly  corked,  and  away 
from  the  light. 

BROMIDES 

Another  soother  of  nervous  irritability  is  one  of  the  alka- 
line bromides.  The  bromide  or  sodium  suits  the  stomach 
better  than  the  potassium  salt.  It  can  be  had  in  tablet  form, 
each  tablet  generally  containing  ten  grains.  An  infant  of 
six  months  would  better  make  four  or  five  doses  of  one  tablet. 
The  tablet  can  be  dissolved  in  water,  and  the  proportionate 
part  given.  Older  children  can  take  larger  doses.  This 
drug  is  not,  however,  to  be  given  carelessly. 


OPIUM   PREPARATIONS 

For  the  relief  of  pain,  no  drug  is  so  efficient  as  opium, 
but  it  is  badly  borne  by  children.  For  nursery  use,  the  only 
preparation  admissible— if  any  be— is  the  paregoric  elixir. 
It  contains  opium  in  the  proportion  of  one  to  two  hundred 
and  fifty  parts.  It  also  contains  camphor  and  anise,  so 
that  its  soothing  effect  is  out  of  proportion  to  its  opium 


THE  HOUSEHOLD  PHARMACY  189 

strength.  An  infant  should  have  no  more  than  five  to  ten 
drops.  It  is  customary  to  print  directions  upon  the  label. 
While  its  action  in  emergencies  and  under  proper  restric- 
tions is  very  pleasant,  its  frequent  and  indiscriminate  em- 
ployment is  only  to  be  condemned. 

VARIOUS  ANTIDOTES 

When  speaking  of  accidental  poisoning,  a  number  of  anti- 
dotes pretty  certain  to  be  in  the  house  were  mentioned.  For 
dwellers  in  towns  it  is  useless  to  provide  any  others.  But 
by  those  living  remote  from  a  pharmacy,  two  or  three  may 
be  found  useful,  if  only  from  the  sense  of  security  they  give. 
These  are:  Tan7iic  acid,  to  be  used  as  an  antidote  for  the 
various  poisonous  plants  and  mushrooms  which  omnivorous 
children  may  eat  (see  p.  181).  It  would  better  be  kept  in 
powders  of  five  grains  each.  In  case  of  poisoning,  give  one 
or  two  powders,  according  to  the  child's  age,  dissolved  in 
water;  repeat  every  quarter  of  an  hour  for  several  doses. 
The  emetic,  of  course,  is  used  first. 

Epsom  salts  (see  p.  180)  is  believed  to  be  the  best  antidote 
for  carbolic  acid.  Dissolve  a  tablespoonful  of  the  salt  in  a 
tumbler  of  water.  Give  as  much  as  the  child  will  take.  It 
may  be  repeated,  as  the  over-effect  of  the  salt  is  trifling  com- 
pared with  that  of  the  carbolic  acid. 

Sulphate  of  copper  (see  p.  180),  or  blue  stone,  is  recom- 
mended as  the  best  emetic  for  phosphorus  (matches)  poison- 
ing, because  of  its  having  the  additional  effect  of  being  an 
antidote.  This  effect  has  been  disputed,  but  its  emetic  power 
is  unquestioned.  The  emetic  dose  for  a  child  is  one  or  two 
grains,  and  powders  or  tablets  of  one  grain  each  make  a  con- 
venient form  for  keeping  the  drug. 


PART  II 
QUESTIONS  AND  ANSWERS 


I 

MINOR  AILMENTS  AND  TROUBLES 

THE   CAUSES  AND   TREATMENT   OF   COLIC 

What  is  the  cause  of  colic? 
Can  anything  be  done  to  prevent  it? 

How  can  a  child  be  relieved  when  suffering  from  an  attack  of 
colic  ? 

Colic  generally  means  a  painful  affection  of  the  intestines, 
but  the  name,  with  certain  qualifying  adjectives,  is  ap- 
plied to  other  painful  troubles.  There  is,  besides  the  pain, 
sometimes  more  or  less  spasm  of  the  bowels.  The  causes,  as 
far  as  applied  to  infants  or  young  children,  are  usually  con- 
nected with  the  digestive  process,  such  as  indigestion  from 
improper  or  excessive  food  or  drinks,  constipation,  fermen- 
tation of  food— producing  gas,  etc.  Besides,  we  may  men- 
tion chilling,  cold  feet,  etc. 

Watching  for  the  dietetic  error  which  causes  the  pain  and 
avoiding  the  repetition  of  the  cause  are  usually  effective. 
If  the  child  has  a  feeble  digestion  it  will  be  necessary  to  im- 
prove, if  possible,  the  digestive  power,  and  to  suit  the  food 
to  the  enfeebled  power  while  it  exists,  and,  in  like  manner, 
to  remove  as  far  as  possible  any  recognized  tendency  or  as- 
signable exciting  cause.  It  is  true  that  some  children  dur- 
ing the  first  months  of  life  show  a  tendency  to  colic  for  which 
an  adequate  cause  cannot  be  easily  discovered.  But  these 
cases  are  relatively  rare. 

13  193 


194  THE  CENTURY  BOOK  FOR  MOTHERS 

The  usual  simple  and  effectual  remedies  are  the  follow- 
ing: Heat  to  the  feet  and  bowels;  the  heat  should  be  as 
great  as  can  comfortably  be  borne,  but  short,  of  course,  of  a 
degree  that  would  damage  the  skin.  If  there  be  gas  in  the 
stomach  or  bowels,  a  change  of  position,  such  as  putting  the 
child  stomach  downward  on  the  hot  application,  together 
with  rubbing  of  the  abdomen  front  and  back,  often  seems  to 
favor  the  escape  of  the  gas,  with  relief  of  the  pain.  If  the 
gas  be  in  the  lower  bowel  it  may  escape  if  a  soft  tube,  such 
as  a  large  catheter,  be  passed  into  the  bowel.  So  also  a  warm 
enema  may  aid  the  expulsion  of  the  gas.  Internally,  hot 
water,  either  alone  or  with  carminatives,  such  as  a  few  drops 
of  peppermint  or  anise  cordial,  or  gin,  or  brandy,  or,  best  of 
all,  although  disagreeable  in  smell,  tincture  of  asafetida  will 
be  found  useful.  This  latter  may  be  given  by  the  mouth  or 
injected  into  the  bowels.  If  the  pain  is  severe,  small  doses 
of  paregoric— proportioned  to  the  age  of  the  child— may  be 
given. 

COLIC   AND   TEETHING 

Will  cutting  the  lateral  incisors  give  a  baby  colic?  It  seems  to 
in  the  case  of  my  baby,  ten  months  old.  I  give  her  capsicum 
tablets  for  it.  Is  there  anything  better  that  you  can  recom- 
mend? 

The  cutting  of  teeth  is  charged  with  many  digestive  disor- 
ders. The  latter  are,  however,  now  attributed,  by  those 
giving  attention  to  such  things,  more  frequently  to  changes 
in  the  development  of  the  digestive  organs  which  occur  at 
the  same  period  as  teething.  It  is,  therefore,  safer  to  say  that 
such  symptoms  accompany  rather  than  depend  upon  teeth- 
ing. Capsicum,  the  oils  of  mint  and  anise,  in  the  shape  of 
cordials,  or  the  tincture  of  the  drug-shops— a  few  drops  in 
hot  water— and  many  other  things  will  relieve  colic.  Hot 
water  alone  is  often  efficient.  Better  is  it,  if  possible,  to 
remove  the  cause. 


MINOR  AILMENTS  AND  TROUBLES  195 


COLIC   ACCOMPANYING   NURSING 

What  is  the  cause  of  my  baby  girl,  two  and  a  half  months  old, 
having  colic  when  she  nurses  f  She  may  have  been  perfectly 
quiet  before  she  began,  and  oftentimes  will  only  take  one  or 
two  swallows  when  the  colic  strikes  her,  and  it  is  only  by 
working  with  her  for  some  time  that  she  can  get  enough  to 
satisfy  her.  The  only  time  that  she  is  not  troubled  is  when 
she  takes  her  one  night  nursing. 

Two  physicians  have  given  her  simple  remedies  for  indigestion, 
but  they  have  had  no  effect;  others  said  the  milk  came  too 
fast,  but  the  above  sentence  disproves  that,  as  naturally  at 
night  it  comes  faster  than  at  any  other  time.  Can  you  tell 
me  what  the  cause  is?  She  sometimes  sleeps  the  whole  morn- 
ing, and  anyway  is  nursed  only  every  two  and  three  quarter 
hours,  yet  always  has  it.  Have  you  ever  had  a  similar  case? 
I  have  not  met  any  one  that  had  ever  heard  of  it.  I  am  not 
alarmed  about  it,  but  I  should  like  to  know  of  something  to 
relieve  her  at  that  time  when  she  ought  certainly  to  be  easy. 
She  is  not  one  bit  sick,  but,  on  the  contrary,  is  thriving  nicely. 

Such  cases  are  by  no  means  rare  in  infancy  or  in  later 
childhood— that  is  to  say,  the  taking  of  food  into  the  stom- 
ach excites  prematurely  the  stomach  and  intestines  to  action. 
We  do  not  knov^  enough  of  your  condition  of  health  or  of 
your  baby's  to  tell  you  what  is  the  exact  cause  in  this  case. 
Sometimes  the  trouble  is  due  to  over-irritability  of  the  diges- 
tive tract  in  the  child,  sometimes  to  some  unsuitableness  of 
the  food— milk,  or  whatever  it  may  be.  In  older  children, 
as  well  as  in  infants,  it  is  not  rare  to  see  a  meal— whether 
from  breast,  bottle,  or  from  table— frequently  or  even  usu- 
ally interrupted  by  a  movement  of  the  bowels.  Doubtless 
your  baby's  case  belongs  to  the  same  group,  although  the 
effect  seems  to  be  limited  to  colicky  pain.  The  fact  that 
the  disturbance  is  less  marked  at  night  does  not  quite  clear 
up  the  matter,  because  your  milk  might  be  better  for  your 
rest,  or  baby's  digestion  better  for  her  rest.  Take  one  of 
your  two  physicians  and  let  him  follow  out  the  matter. 


196  THE  CENTUEY  BOOK  FOR  MOTHERS 


"THREE-MONTHS'   COLIC" 

Please  tell  me  something  about  the  legitimate  remedies  for 
"three-months'  colic"  in  infants.  I  am  entirely  without  ex- 
perience, and,  with  the  advice  of  nurses,  friends,  and  doctors, 
have  rung  the  changes  on  "carminatives" — catnip-tea,  soda- 
mint,  gin  and  fennel,  etc.     Are  these  all  harmful? 

Catnip-tea,  given  hot,  and  soda-mint,  dissolved  in  hot  water, 
are  both  safe  and  useful  in  relieving  colic;  but  it  is  best 
to  search  for  causes.  Children  have  colic  at  all  ages.  It 
is,  perhaps,  more  frequent  at  the  age  mentioned  than  ear- 
lier, because  the  little  one  has  gained  more  independence 
of  action,  kicks  its  covers  off  and  so  gets  chilled,  and  is  in 
warm  climates  or  seasons  often  placed  upon  the  floor.  Be- 
sides—and perhaps  this  is  most  important  of  all — certain 
processes  of  development  in  the  intestinal  canal  make  the 
child  at  this  age  more  susceptible  to  derangement  from  all 
causes.  A  child  that  has  shown  the  colicky  tendency  should 
be  carefully  protected  about  the  bowels  at  all  times ;  should 
not  be  allowed  to  become  constipated ;  if  fed,  should  have  its 
food  prepared  with  great  circumspection ;  if  suckled,  its 
mouth  and  the  nipple  should  be  kept  particularly  clean  to 
avoid  any  source  of  fermentation  which  might  act  upon  the 
milk. 

CURE  FOR   COLD   HANDS 

Can  you  tell  me  why  my  little  boy  of  ten  months  has  almost 
always  cold  hands?     He  seems  to  be  in  good  health  otherwise. 

The  commonest  causes  of  cold  hands  in  little  children  are 
poor  nutrition,  feeble  circulation,  or  undue  perspiration. 
The  cure  must  lie  in  the  improvement  of  the  nutrition  and 
tone,  but  some  help  may  come  from  the  addition  of  salt  to 
the  daily  bath,  and  the  sponging  of  the  body,  rather  than  its 
immersion  in  water. 


MINOR  AILMENTS  AND  TROUBLES  197 


COLD   FEET   AS  A   CONSEQUENCE  OF   SHORT   CLOTHES 

Can  you  tell  me  how  to  keep  my  little  girl's  feet  warm  through 
the  day?  She  is  eight  months  old,  has  always  been  strong 
and  well,  is  plump,  and  has  rosy  cheeks.  I  put  her  into  short 
clothes  a  month  ago,  putting  on  long  woolen  stockings  and  the 
little  soft,  solid  shoes  that  come  for  the  first  wearing.  At 
night,  when  I  undress  her,  her  little  feet  are  very  cold  and 
clammy. 

It  is  not  very  easy  to  keep  quite  warm  the  feet  of  a  baby  who 
is  short-coated  in  winter.  The  first  effect  of  shoes  is  rather 
to  retard  the  circulation  in  the  feet  by  diminishing  the  play 
of  the  muscles.  Little  ones  who  are  very  vigorous  often 
have  the  feet  and  hands  considerably  colder  than  the  body 
or  the  limbs.  The  best  way  we  know  is  to  have  the  shoes 
and  stockings  very  large,  to  make  sure  that  the  feet  are 
quite  warm  when  put  into  their  coverings,  and  if  this  alone 
does  not  succeed,  to  take  off  the  shoes  and  stockings  in  the 
middle  of  the  day,  rub  and  warm  the  feet,  and  reclothe  them. 
See  also  that  the  napkins  are  not  so  tight  as  to  prevent  exer- 
cise of  the  limbs. 

PERSPIRING   FEET 

My  little  girl,  aged  four,  perfectly  healthy  apparently,  has  each 
night  her  stockings  and  shoes  damp  with  perspiration.  I  am 
sure  it  cannot  be  because  her  feet  are  too  warm,  for  our  home 
is  in  the  country  and  the  floors  are  not  over-warm.  Can  you 
suggest  the  cause  and  cure?  Though  she  never  complains,  it 
would  seem  as  if  her  feet  must  be  cold  from  the  dampness. 

Perspiration  of  the  feet  is  sometimes  a  personal  peculiarity, 
the  cause  of  which  is  not  easy  to  discover,  or  is  practically 
impossible  to  remove.  But  as  a  common  cause  is  an  imper- 
fect circulation,  it  is  always  well  to  search  for  anything  that 
may  retard  the  flow  of  blood  from  the  feet.  See  if  the  stock- 
ings and  shoes  are  wide  and  easy;  if  there  is  any  undue 


198       THE  CENTURY  BOOK  FOR  MOTHERS 

tightness  at  the  knee,  etc.  Watch  if  the  palms  also  perspire 
when  covered  by  mittens ;  if  so,  it  will  show  that  the  peculi- 
arity is  a  general  one,  and  not  confined  to  the  feet.  It  may 
be  noted  that  people  of  the  '' rheumatic"  habit  are  thought 
to  perspire  more  than  others. 

ENLARGEMENT   OF   GLANDS 

My  baby  has  a  kernel  about  the  size  of  a  small  bird's  egg  on  the 
left  side  of  her  neck,  also  two  behind  each  ear  the  size  of  peas. 
The  kernels  have  been  there  two  months.  Can  you  tell  me  if 
that  is  anything  serious?  She  is  thirteen  months,  has  six 
teeth,  and  is  a  healthy  baby;  although  she  looks  delicate,  she 
is  very  bright,  walks  and  talks. 

The  kernels  are  enlarged  lymphatic  glands.  Their  enlarge- 
ment has  come  from  an  irritation  elsewhere,  such  as  en- 
larged or  inflamed  tonsils,  some  eruption,  scratches,  or  what 
not.  The  glandular  enlargements  often  persist  long  after 
the  trouble  which  gave  rise  to  them  has  been  forgotten.  They 
are  probably  not  serious.  Sometimes  they  gather,  or  have 
to  be  removed,  but  in  the  great  majority  of  cases  the  glands 
return  to  their  natural  size  with  the  disappearance  of  the 
exciting  cause. 


PROBABLE   CAUSE   OF   MOUTH-BREATHING 

Will  you  kindly  tell  me  how  I  can  break  my  little  baby,  two 
months  old,  of  the  habit  of  sleeping  with  his  mouth  open?  It 
seems  to  me  advisable  to  stop  his  doing  so  at  once. 

Inasmuch  as  the  habit  of  sleeping  with  the  mouth  open  is 
usually  due  to  obstructions  in  the  nasal  passages,  it  is  very 
difficult  to  break  up  the  habit  until  the  obstruction  is  re- 
moved. In  older  children  the  usual  obstruction  is  from  an 
adenoid  growth  in  the  back  of  the  nose  (pharynx).  But  in 
a  very  young  baby  this  is  probably  not  the  case.  Look  into 
the  throat  to  see  if  the  tonsils  are  large.     Examine  the  nos- 


MINOR  AILMENTS  AND  TROUBLES  199 

trils  to  see  if  they  be  wide  enough,  or  choked  with  mucus. 
If  you  cannot  find  a  cause,  ask  your  physician. 


ENLARGED  UVULA 

I  am  prompted  to  ask  your  advice  concerning  what  seems  to  be 
a  chronic  enlargement  of  the  uvula  and  soft  palate  in  my 
little  four-and-a-half-year-old  son.  To  this  enlargement  our 
local  physician  attributes  the  child's  inability  to  speak  plainly 
and  his  difficult  breathing  at  night.  But  this  same  physician 
assures  me  the  child  will  outgrow  the  trouble.  The  boy  is  a 
strong,  sturdy  child,  weighing  forty-six  pounds,  and  of  good 
height,  thoroughly  healthy,  so  far  as  I  know.  But  the  slight- 
est cold  settles  immediately  in  the  uvula,  causing  the  child 
untold  trouble  as  soon  as  he  lies  down,  with  an  almost  constant 
throat-cough,  which  very  often  results  in  nausea.  His  breath- 
ing at  night  is  always  impeded;  his  mouth  is,  at  night,  usu- 
ally open,  and  he  snores  very  audibly.  Altogether  the  symp- 
toms are  to  me  distressing,  and  I  turn  to  you  for  advice  as  to 
what  should  be  done,  since  it  seems  to  me  a  case  which  should 
not  be  left  for  the  child  to  outgrow,  if,  indeed,  he  ever  may. 

"We  should  advise,  first,  the  examination  of  the  pharynx  to 
see  if  there  is  also  an  obstruction  there  besides  the  enlarged 
uvula.  If  there  is,  the  cause  of  the  obstruction  would  much 
better  be  removed.  If  the  pharynx  is  clear,  then  we  think 
such  a  uvula  as  you  describe,  which  is  sufficiently  enlarged 
to  impede  breathing,  should  be  cut  off,  even  if  in  time  it 
would  shrink,  for  the  boy  will  suffer  damage  in  the  meantime. 


PATCHES   ON   THE   TONGUE 

For  a  year  past  I  have  noticed  in  regard  to  my  little  boy,  who  is 
now  two  years  of  age,  that  the  tongue  is  very  often  covered 
here  and  there  with  small  white  patches.  Sometimes  they  are 
red  in  the  center  with  a  white  rim.  The  child  has  always 
been  very  pale,  but,  with  that  exception,  has  seemed  very  well 
and  full  of  life,  scarcely  ever  having  suffered  from  even  a 


200  THE  CENTURY  BOOK  FOR  MOTHERS 

cold.  He  weighs  thirty  pounds,  and  his  flesh  is  firm  and  solid. 
He  enjoys  a  good  appetite,  and  I  have  always  tried  to  be  care- 
ful concerning  his  diet.  He  takes  cereals  for  breakfast  at 
8  A.M.,  and  nearly  always  calls  for  a  second  saucerful,  seldom 
taking  anything  else,  except  a  cup  of  milk  and  an  oaten  flake- 
cracker.  Occasionally  he  will  eat  the  yolk  of  a  soft-boiled 
egg  with  bread  for  a  change,  and  he  is  fond  of  apple-sauce, 
but  generally  takes  what  I  first  mentioned. 

Until  within  a  couple  of  months  he  took  a  lunch  of  oatmeal 
crackers  and  milk  at  eleven,  and  his  dinner  at  two.  He  has 
now  dispensed  with  the  lunch  and  takes  his  dinner  at  one, 
eating  a  plate  of  chicken,  beef,  or  mutton  broth,  with  rice, 
bread  and  butter,  and  a  cup  of  milk.  He  varies  this  with 
cream  toast  or  bread  and  butter  and  a  little  beef,  mutton,  or 
chicken  cut  up  fine,  but  eats  very  few  vegetables,  almost  none. 
He  likes  plain  rice  pudding,  junket,  or  custards,  which  I  occa- 
sionally give  him  for  dessert.  He  takes  his  supper  at  5:45, 
of  a  couple  of  slices  of  bread  crumbed  in  warm  milk,  after 
which  he  is  off  to  bed,  and  is  a  good  sleeper.  He  never  asks 
for  anything  between  meals,  though  I  have  given  him  an  apple 
at  times,  which  he  has  seemed  to  enjoy.  I  peeled  it  and  cut  it 
in  small  pieces.  It  did  not  seem  to  hurt  him,  though  I  thought 
it  best  to  ask  your  advice  before  continuing  it. 

Can  you  enlighten  me  in  regard  to  the  patches  on  the  tongue — 
the  cause,  and  what  to  do  to  overcome  the  trouble? 

In  all  probability  the  patches  are  those  of  common  sprue, 
although  the  child  is  rather  old  to  have  this  disorder.  The 
real  cause  is  a  microscopic  plant  akin  to  the  yeast-plant.  It 
may  be  acquired  from  the  air  at  any  time,  but  some  con- 
ditions not  those  of  perfect  health  seem  necessary  to  its 
growth,  the  chief  of  which  is  acidity  of  the  secretions  of  the 
mouth  from  any  cause.  Sweet  food,  starchy  food,  the  re- 
mains of  milk,  etc.,  may  ferment  in  the  mouth  and  give  the 
requisite  condition  for  the  development.  Prevention  is  best 
secured  by  being  careful  about  sweets  and  cleansing  the 
mouth  after  eating,  using  an  alkali  to  secure  alkalinity  of 
the  mouth.  Lime-water  will  do,  but  a  favorite  one  is  borax, 
which  unites  with  slight  alkalinity  the  disinfecting  power 


MINOR  AILMENTS  AND  TROUBLES  201 

of  the  boric  acid.  A  solution  of  borax  with  a  little  extra 
boric  acid  added  is  very  good— say,  dissolve  a  heaped  tea- 
spoonful  of  powdered  borax  in  a  teacupful  of  water,  then 
add  half  a  teaspoonful  of  boric  acid  and  stir  until  the 
whole,  or  as  much  as  possible,  is  dissolved.  First  clean  off 
the  spots  as  well  as  you  can  with  a  soft  rag  over  the  tip  of 
your  finger.  Then  wash  the  tongue  well  with  a  rag  dipped 
in  the  solution.  The  latter  is  better  if  you  add  to  it  a  des- 
sertspoonful of  glycerin.  If  the  mouth  is  kept  alkaline,  as  it 
naturally  is,  the  plant  will  hardly  grow.  Of  course,  the 
kinds  of  food  likely  to  favor  the  growth  should  be  restricted 
during  the  presence  of  the  growth— that  is  to  say,  starchy  or 
sweet  foods. 

There  seems  to  be  nothing  out  of  the  way  in  the  diet  if  the 
digestion  is  adequate,  and  you  do  not  speak  of  anything  to 
the  contrary.  There  are  few  fruits  which  are  distinctly  use- 
ful except  when  fresh,  although  many  are  admissible.  So 
of  vegetables ;  there  are  very  few,  we  think,  which  are  really 
advantageous  at  two  years  of  age.  Yet  some  children  can 
bear  them  without  evident  indigestion.  The  parent  usually 
thinks  of  a  dietary  as  containing  all  the  things  that  can  be 
given  without  positive  and  immediately  recognizable  harm; 
the  medical  adviser,  on  the  other  hand,  thinks  of  a  dietary 
as  made  up  of  articles  really  desirable  as  food,  and  some 
innocent  indulgences  to  tempt  the  palate.  Between  these 
plans  a  good  deal  of  room  for  judgment  is  left,  and  the  best 
of  this  judgment  lies  in  the  application  of  general  rules  to 
the  particular  case.  Our  own  inclination  is  always  to  give 
rather  less  than  the  digestion  could  carry— that  is,  to  leave 
a  little  reserve  digestive  power. 


COATED   TONGUE 

My  two  little  girls  have  always  been  very  healthy  children,  nei- 
ther having  had  even  the  common  eruptions  or  rashes  inciden- 
tal to  infancy;  but  the  elder,  three  and  a  half  years  old,  has 
always  had  a  white-coated  tongue,  except  at  very  rare  inter- 


202       THE  CENTURY  BOOK  FOR  MOTHERS 

vals.  She  is  the  picture  of  fair,  robust,  rosy  childhood,  per- 
fectly sound  in  every  way  apparently.  Can  you  account  for 
this  seemingly  incongruous  case?  I  sometimes  feel  anxious 
about  it,  as  such  a  tongue  is  usually  regarded  as  indicating 
a  disordered  stomach;  but  this  cannot  be  so,  as  I  am  and  al- 
ways have  been  particular  as  to  food,  regular  hours  and 
habits,  clothing,  etc.,  which  are  such  as  I  think  you  would 
approve  of. 

We  cannot,  of  course,  tell  why  the  child's  tongue  is  white. 
It  is  noticeable  in  some  children  and  adults  without  any 
corresponding  symptoms  of  stomach  disorder.  And  we  have 
noticed  that  some  persons,  when  using  a  milk  diet,  even  if 
wdth  pleasure  and  apparent  benefit,  have  a  slight  whitish 
coat  or  coloration  upon  the  tongue.  If  you  can  find  no  other 
evidence  of  ill  health,  we  think  you  may  safely  disregard 
the  symptom. 

THE   PREVALENCE   OF   "SORE   MOUTH" 

Is   sore   mouth   ever   epidemic   among  young   babies?     A   great 
many  have  had  it  in  the  locality  where  I  live. 

The  difficulty  of  answering  this  question  lies  in  its  vague- 
ness, the  writer  apparently  supposing  that  sore  mouth  in 
children  is  always  the  same  thing.  There  is,  first  of  all,  the 
catarrhal  sore  mouth,  which  is  sometimes  associated  with 
teething  or  with  any  irritation  of  the  mouth,  and  which  has 
been  known  to  follow  so  slight  a  cause  as  crying  or  too  long 
use  of  the  voice.  The  kinds  of  sore  mouth  that  are  some- 
times very  prevalent  are  the  aphthous  variety,  popularly  the 
''sprue,"  which  is  often  seen  in  infants  with  disordered  di- 
gestion or  those  who  are  somewhat  debilitated.  Under  local 
depressing  circumstances,  such  as  dampness  or  unwholesome 
situation  of  the  house,  the  disease  may  be  very  prevalent. 
Another  form— popularly ''thrush  "—is  due  to  the  presence  of 
a  parasitic  growth,  and  this  may  be  propagated  by  contagion, 
as  in  passing  a  nursing-bottle  from  one  mouth  to  another. 


MINOR  AILMENTS  AND   TROUBLES  203 

THE    CAUSES   OF   SORE   MOUTH 

My  baby  is  troubled  with  a  very  sore  mouth,  which  is  exceed- 
ingly painful  when  she  drinks.  I  have  heard  of  bottle  babies 
suffering  thus  for  months,  the  ulcers  often  leaving  scars  for 
years.  Is  this  the  common  fate  of  all  poor  babies  who  must 
nurse  from  a  bottle,  and  is  there  no  preventive  or  cure?  It 
seems  to  be  a  rubber  poison.  I  have  read  of  silver  and  por- 
celain nipples,  but  have  been  unable  to  find  any.  Do  you 
know  where  such  articles  can  be  purchased? 

It  is  not  the  ^'common  fate"  of  bottle  babies.  Some  babies 
who  are  feeble  get  sore  mouths,  whether  on  the  bottle  or 
the  breast.  The  commonest  cause  of  sore  mouths  is  neglect 
of  the  details  of  tidiness.  The  rubber  nipples  should  be 
carefully  scrubbed  and  cleaned,  and  such  cleansing  would 
be  just  as  necessary  if  you  had  metal,  porcelain,  or  even 
glass  nipples.  Besides,  the  child's  mouth  should  be  cleansed 
before  nursing,  and  quite  thoroughly  after  nursing  if  a  ten- 
dency to  sore  mouth  exists.  Ordinary  borax  or  boric-acid 
solutions  are  good,  but  others  are  used,  according  to  the  con- 
dition of  the  mouth,  as  directed  by  the  physician.  Metal 
and  porcelain  nipples  are  objectionable,  especially  the  metal, 
even  if  they  can  be  obtained.  We  have  not  seen  one  in  a 
great  while.  The  old  ivory  mouth-piece,  too,  has  gone  into 
deserved  retirement.  Rubber  nipples  of  good  quality,  if 
properly  cared  for,  will  give  you  little  trouble,  we  think. 


SWOLLEN   TONSILS 

My  little  boy,  who  is  just  four  years  old,  is  troubled  with  swol- 
len tonsils.  During  sleep  he  snores  distressingly,  and  he  has 
frequent  colds  in  the  head.  Our  physician  thinks  it  would  be 
best  to  cut  the  tonsils,  but  I  dread  the  operation,  and  many 
friends,  some  of  them  experienced  mothers,  warn  me  against 
allowing  the  operation  to  be  performed.  They  tell  me  that  he 
may  outgrow  the  trouble ;  that  the  operation,  performed  at  this 
early  age,  might  have  to  be  repeated,  and  that,  as  he  is  the 


204  THE  CENTURY  BOOK  FOR  MOTHERS 

picture  of  rosy  health,  the  swollen  tonsils  and  labored  breath- 
ing at  night  cannot  be  doing  him  any  injury.  I  am  very 
much  troubled  about  the  matter,  and  am  anxious  to  have  your 
advice.  Does  this  condition  of  the  throat  predispose  to  diph- 
theria? What  home  treatment  would  you  suggest  to  diminish 
the  swelling? 


Of  course,  it  is  impossible  for  us  to  give  a  decided  opinion 
as  to  this  particular  case;  but,  in  a  general  way,  something 
may  be  said.  Even  if  the  phrase  "swollen  tonsils"  be  lim- 
ited in  meaning  to  express  only  a  condition  of  some  dura- 
tion, it  does  not  always  mean  the  same  thing.  In  health  the 
tonsil  is  very  small— so  small  that  some  who  have  studied 
throat  diseases  particularly  think  that  it  does  not  exist  in 
the  sense  of  being  a  visible  prominence.  Now,  Avhen  the 
tonsil  becomes  enlarged  and  remains  so,  it  may  be  from 
removable  causes  and  conditions,  or  it  may  not.  Stripped 
of  all  technicality,  the  one  group  of  cases  may  be  consid- 
ered as  those  in  which  much  of  the  enlargement  is  due  to 
an  excess  of  blood  in  the  tissues,  and  the  other  group  em- 
braces cases  in  which  actual  overgrowth  of  the  tonsil  has 
occurred.  In  the  former  cases  the  enlargement  may  dimin- 
ish until  the  tonsil,  while  still  larger  than  proper,  gives  no 
very  great  trouble.  In  the  latter,  the  most  experienced  ob- 
servers doubt  if  any  treatment  short  of  removal  of  the  tonsil 
by  some  means  is  of  much  value.  The  popular  ideas  about 
outgrowing  the  condition  are  based  partly  upon  the  false 
assumption  that  w^hat  is  really  a  considerably  enlarged  ton- 
sil is  the  natural  state  of  things,  and  partly  upon  the  in- 
ability of  non-professional  observers  to  distinguish  between 
the  temporary  swelling  of  the  tonsils,  the  chronically  en- 
gorged tonsils,  and  the  really  overgrown  tonsils.  Now^,  the 
opinion  of  the  most  ''experienced  mother"  can  be  of  no 
value  here.  She  cannot,  at  the  outside,  have  seen  more  than 
two  or  three  cases  of  the  last-mentioned  variety.  It  is  fair 
to  presume  that  if  you  have  a  family  physician  you  have 
chosen  him  because  you  believe  him  to  be  skilful  and  con- 


MINOR  AILMENTS  AND  TROUBLES  205 

scientious.  That  being  the  case,  it  is  probable  that  such  a 
man  would  not  advise  cutting  off  the  tonsils  if  he  believed 
he  could  accomplish  a  cure  by  any  less  severe  method.  If 
you  are  not  content  to  rely  on  his  judgment  alone,  get  that 
of  another  physician,  but  do  not  ask  or  accept  lay  advice. 
So  much  for  the  "outgrowing"  of  the  disease.  As  to  the 
need  of  repeating  the  operation,  only  this  need  be  said: 
The  operator  does  not  undertake  to  put  the  patient  into  better 
health  than  he  had  before  the  disease  began.  It  is  very 
common  to  find  people  who  suppose  that  after  an  operation 
they  can  with  impunity  follow  the  same  faulty  course  of  life 
that  originally  caused  the  disease  for  which  the  operation 
was  made.  If  the  tonsils  are  removed  the  same  care  must 
be  observed  to  prevent  new  trouble  as  would  be  requisite  to 
cure  the  enlargement  if  it  were  of  the  kind  curable  without 
operation.  As  a  matter  of  experience,  however,  it  is  true 
that  if  the  tonsil  is  thoroughly  removed  at  first  a  second 
operation  is  rarely,  if  ever,  required.  ''Outgrowing"  the 
disease  is  a  bad  name,  since  it  conveys  the  idea  that  the 
simple  lapse  of  time  and  increase  of  stature  are  sufficient 
for  the  purpose.  This  is  only  the  case  when  improved  health 
comes  with  the  lapse  of  time.  And  in  this  disease  this  im- 
provement is  the  result  of  very  persistent  watching  as  to  all 
the  details  of  hygiene,  local  and  general,  in  the  widest  sense 
of  the  word. 

This  may  sound  strange  as  applied  to  one  who  is  the 
''picture  of  rosy  health,"  but  we  have  so  often  heard  this 
epithet  applied  to  children  who  did  not  at  all  correspond  to 
a  physician's  idea  of  health — indeed,  have  so  often  been 
asked  to  admire  the  very  evidences  of  disease— that  we  are 
obliged  to  disregard  such  general  statements. 

While  there  is  every  reason  to  suppose  that  diphtheria 
is  due  to  a  special  poison,  it  is  also  true  (to  quote  from  a  well- 
known  authority)  that  "any  abnormal  state  of  the  mucous 
membrane  .  .  .  affords  an  excellent  abode  for  diph- 
theria." The  home  treatment  is  suggested  in  what  has  al- 
ready been  said  regarding  hygiene. 


206  THE   CENTURY  BOOK  FOR  MOTHERS 

ROUGHNESS   OF   THE   VOICE 

I  have  for  some  time  been  worried  about  my  boy  of  six  months. 
Ever  since  he  was  a  few  months  old  I  have  noticed  that  his 
voice  is  rough,  sometimes  very  little,  at  other  times,  and  espe- 
cially after  crying,  so  much  so  that  he  can  hardly  make  a 
sound.  My  physician  seemed  to  attach  no  importance  to  it, 
but  it  worries  me  to  think  that  he  might  keep  it,  and  I  should 
like  to  ask  what  I  might  do  for  it,  and  if  there  is  any  danger 
of  the  voice  remaining  rough.  The  boy  is  otherwise  perfectly 
well,  never  had  any  trouble,  and  is  not  yet  teething. 

The  roughness  of  the  voice  is  probably  due  to  some  relaxa- 
tion of  the  vocal  cords  or  some  congestion  of  the  mucous 
membrane.  The  latter  explanation  would  more  likely  accord 
with  the  fact  of  the  roughness  coming  after  crying.  As  to 
the  probable  duration  of  this  condition,  we  can  give  no  opin- 
ion which  would  be  more  than  a  guess. 

BED-WETTING 

My  little  boy  is  nearly  three  years  of  age,  and  very  healthy  and 
strong,  but  he  persists  in  wetting  his  bed  nearly  every  night, 
despite  punishment,  restricted  diet,  etc.  I  know  positively  the 
trouble  is  not  due  to  phimosis. 

First  of  all,  it  should  be  remembered  that  the  relative 
positions  of  a  little  child's  bladder  and  urethra  are  different 
from  what  these  will  be  later  in  its  life,  and  that  bed-wetting, 
even  if  very  obstinate,  usually  is  overcome  ultimately,  both 
by  the  real  developmental  changes  and  by  the  less  sound 
sleep  of  later  childhood.  We  think  that  bed-wetting  in 
young  children  is  never  a  subject  for  punishment.  You  say 
that  you  are  sure  that  no  phimosis  exists.  In  connection 
with  bed-wetting,  this  means  that  the  foreskin  cannot  only 
be  drawn  back,  but  completely  back,  so  that  there  are  no 
adhesions  or  sources  of  irritation  behind  the  ridge  of  the 
glands.  But  we  accept  your  statement  in  full  and  leave  this 
cause.     In  addition,  you  have  tried  restricted  diet,  which  we 


MINOR  AILMENTS  AND  TROUBLES  207 

suppose  includes  restricted  liquids  of  all  sorts  near  bed- 
time. After  the  local  irritation  of  phimosis  and  the  me- 
chanical distention  of  a  bladder  owing  to  liquids,  one  natu- 
rally thinks  next  of  local  irritations  in  the  bowel  from 
constipation  or  worms ;  next,  of  irritation  of  the  bladder  from 
urine  too  concentrated  or  containing  irritating  matters  from 
a  diet  too  rich  in  elements  which  go  to  make  urates  in  the 
urine.  Questions  of  too  much  or  too  little  covering  in  bed 
have  to  be  considered,  and  a  variety  of  lesser  causes,  but 
those  mentioned  are  the  obvious  and,  we  think,  the  more 
common  ones.  There  is,  however,  always  a  considerable  resi- 
due of  cases  which  seem  to  be  not  dependent  upon  them,  or 
at  least  not  upon  any  one  of  them— cases,  for  instance,  in 
which  the  sleep  is  so  deep  that  many  functions  are  performed 
unconsciously,  others  where  there  seems  to  be  an  unusual 
sensibility  of  the  urinary  organs.  In  the  former  group  the 
best  safeguard  is  the  constant  watching  of  the  child  and  the 
taking  it  up  at  various  times  in  the  night  before  the  blad- 
der has  had  time  to  fill  to  the  danger  point.  For  the  latter 
type  some  drugs  have  proved  very  useful.  But  inasmuch  as 
they  (for  instance,  belladonna,  which  is  one  of  the  best)  are 
mainly  drugs  of  serious  potency,  their  use  ought  to  be  espe- 
cially directed  and  carefully  watched  by  a  physician. 


BED-WETTING   IN   A   NERVOUS   CHILD 

My  little  boy  of  five  still  wets  the  bed  every  night.  He  is  a  very 
nervous  child,  and  I  do  not  want  to  resort  to  discipline  in 
order  to  cure  him  of  the  habit.  What  is  the  cause  of  it,  and 
what  is  the  best  treatment  that  you  can  suggest? 

''Discipline,"  in  the  sense  of  punishment,  would  be  entirely 
out  of  place  for  a  trouble  of  this  kind,  and,  in  the  case  of  a 
nervous  child,  would  be  distinctly  harmful.  The  bladder 
trouble  is  sometimes  very  obstinate,  taxing  the  ingenuity  of 
both  parent  and  physician;  but,  on  the  other  hand,  it  some- 
times promptly  yields  to  treatment.     We  presume  the  child 


208       THE  CENTURY  BOOK  FOR  MOTHERS 

does  not  waken,  so  as  to  give  the  mother  a  chance  to  place 
him  on  the  vessel.  The  bladder  is  thus  overfull— or  fuller 
than  it  can  tolerate— before  he  awakes.  Such  cases  often 
occur,  and  often  are  cured  by  the  systematic  practice  of 
waking  the  child  at  the  hour  of  the  parents'  retiring,  or  later 
in  the  night,  so  that  the  bladder  may  be  relieved.  Of  course, 
a  nervous  child  should  be  wakened  gently,  so  that  it  will 
not  be  frightened;  but  it  should  be  sufficiently  awakened  to 
be  conscious  of  the  reason  of  its  being  taken  up.  Nervous 
children  often  manifest  especial  irritability  of  the  bladder, 
and  need  systematic  medicinal  treatment.  The  management 
of  this  is  too  complicated  an  undertaking  for  domestic  prac- 
tice, and  cannot  be  entered  upon  here.  If  the  habit  of  tak- 
ing up  your  little  boy  in  the  night,  after  limiting  the  amount 
of  liquid  taken  before  retiring,  does  not  relieve  him,  ask  the 
advice  of  the  best  physician  within  reach.  The  drugs  needed 
are  too  potent  for  you  to  deal  with  without  a  physician's 
prescription  and  directions. 

THE  CAUSE  AND  CURE  OF  HICCOUGH 

My  baby,  a  little  girl  now  seven  and  a  half  months  old,  has  al- 
ways been  troubled  with  hiccough.  For  the  first  three  months 
her  food  was  what  nature  provided;  then  that  proved  insuffi- 
cient, and  the  insufficiency  was  made  good  by  cow's  milk, 
upon  which  she  has  thrived.  It  is  now  her  only  food,  and  she 
is  healthy,  hearty,  and  happy,  but  is  troubled  very  often  with 
hiccoughs.  She  has  them  as  often  as  four  or  five  times  some 
days,  and  perhaps  next  day  will  not  have  a  single  attack.  She 
is  now  fed  at  intervals  of  four  hours  during  the  day,  and  gets 
one  light  meal  at  night. 

I  have  sought  information  of  my  nurse  and  of  persons  who  have 
had  large  experience  with  children,  and  have  received  the  uni- 
form, highly  unsatisfactory  reply:  "Babies  who  have  hic- 
coughs always  thrive."  Can  you  throw  some  light  on  the 
probable  cause  and  suggest  a  remedy?  I  have  used  liquor  of 
pepsin,  sugar  and  sweetened  water  (both  warm  and  cold). 
They  give  only  temporary  relief.  I  would  like  to  strike  at 
the  root  of  the  matter.  I  hope  your  reply  may  help  other 
inexperienced  mothers. 


MINOR  AILMENTS  AND   TROUBLES  209 

Hiccough  is  a  spasmodic  contraction  of  the  diaphragm,  which 
arises  from  a  multitude  of  causes.  While  in  some  diseases 
it  is  a  grave  symptom,  it  is  usually  only  a  passing  annoy- 
ance, and  of  this  type  is  common  hiccough  of  babies.  The 
real  physiological  reasons  of  hiccough  are  not  well  under- 
stood, but  the  exciting  causes  are.  For  babies  the  common- 
est causes  are  simple  overfulness  of  the  stomach  or  pressure 
upward  of  the  stomach  or  abdominal  organs  from  any  cause 
(tossing  the  baby  or  a  sudden  motion  from  alarm  may  ex- 
cite it) .  What  the  particular  cause  in  any  given  case  is, 
only  a  close  observer  of  that  case  can  tell. 

Some  mothers  have  commented  on  the  value  of  crying  as 
a  remedy.  Recently  in  several  medical  journals  the  fact 
that  sneezing  is  a  cure  has  been  discussed.  The  explanation 
of  both  seems  to  be  this:  Hiccough  is  a  disturbance  of  the 
ordinary  respiratory  movements;  so  is  sneezing  and  so  is 
crying.  If  the  one  disturbance  comes  on,  the  other  ceases. 
Every  one  must  have  noticed  the  similarity  between  hic- 
cough and  the  violent  sobs  following  a  hard  fit  of  crying 
with  some  children.  It  is  not  necessary  that  a  person  actu- 
ally sneeze  to  produce  the  desired  effect ;  tickling  or  gentle 
irritation  of  the  nasal  mucous  membrane  is  usually  enough 
to  stop  the  hiccough. 

This  remedy,  it  has  been  pointed  out  by  Dr.  Gibson,  is 
as  old  as  Hippocrates,  who  says:  "Sneezing  occurring  after 
hiccough  removes  the  hiccough."  Dr.  Burnett,  in  a  letter 
to  the  "Medical  Record,"  says: 

"When  devoting  a  leisure  hour  to  Plato's  'Dialogues,'  as 
translated  by  Jowett,  I  was  struck  by  a  passage  in  the  Sym- 
posium which  had  never  arrested  my  attention  before. 
Translated  by  Jowett,  it  stands  thus :  '  When  Pausanias  came 
to  a  pause,  Aristodemus  said  that  the  turn  of  Aristophanes 
was  next,  but  that  either  he  had  eaten  too  much,  or  from 
some  other  cause  he  had  the  hiccough,  and  was  obliged  to 
change  with  Eryximachus,  the  physician,  who  was  reclining 
on  the  couch  below^  him.  "Eryximachus,"  said  he,  "you 
ought  either  to  stop  my  hiccough  or  to  speak  in  my  turn 
until  I  am  better."  "I  will  do  both,"  said  Eryximachus. 
u 


210       THE  CENTURY  BOOK  FOR  MOTHERS 

*'I  will  speak  in  your  turn,  and  do  you  speak  in  mine;  and 
while  I  am  speaking,  let  me  recommend  you  to  hold  your 
breath,  and,  if  this  fails,  then  to  gargle  with  a  little  water; 
and  if  the  hiccough  still  continues,  tickle  your  nose  with 
something  and  sneeze ;  and  if  you  sneeze  once  or  twice,  even 
the  most  violent  hiccough  is  sure  to  go.  In  the  meantime  I 
will  take  your  turn,  and  you  shall  take  mine."  "I  will  do 
as  you  prescribe,"  said  Aristophanes;  "and  now  get  on."  ' 
"The  hiccough  was  not  cured  by  the  first  nor  by  the  sec- 
ond remedy  suggested  by  Eryximachus,  but  by  the  produc- 
tion of  sneezing.  The  method  of  tickling  the  nostrils  has 
been  tested  by  us  in  cases  of  obstinate  hiccough,  and  has  been 
very  successful.  It  is  not  necessary  that  the  stimulus  ap- 
plied to  the  nose  be  followed  by  sneezing ;  the  application  of 
a  gentle  irritant  to  the  nasal  mucous  membrane  may  be  quite 
enough  to  put  a  stop  to  the  hiccough,  by  diverting  the  ner- 
vous energy  into  other  channels,  although  it  may  not  be  of 
sufficient  power  to  induce  sneezing." 


EXCESSIVE   NOSEBLEEDING 

My  baby,  six  months  old,  had  a  severe  attack  of  "nosebleed." 
She  woke  from  a  sound  sleep,  and  blood  commenced  flowing 
and  continued  for  some  ten  minutes.  Is  such  an  occurrence 
a  rare  thing  for  an  infant,  or  does  it  indicate  some  serious 
trouble?  She  was  perfectly  well  before  the  attack,  and  seems 
so  since.  Can  you  suggest  a  way  to  stop  the  flow  should  it 
again  occur?  Our  family  doctor  says  he  never  knew  of  a 
similar  case,  and  volunteers  no  opinion. 

It  is  an  unusual  case.  If  it  recurs,  the  safest  and  quickest 
remedy  we  can  suggest  is  syringing  the  nose  with  quite  cold 
or  with  hot  water.  A  hot  solution  of  alum  is  also  quite 
efficient— a  teaspoonful  of  powdered  alum  to  a  pint  of  hot 
water.  If  it  should  again  occur,  however,  the  nose  should 
be  examined  thoroughly  to  see  if  any  local  cause— a  small 
sore  or  anything  of  the  kind— exists.     This  is  sometimes  the 


MINOR  AILMENTS  AND  TROUBLES  211 

case,  and  a  little  local  treatment  may  save  much  bleeding, 
which  is  particularly  desirable,  as  babies  feel  the  loss  of 
blood  relatively  more  than  adults. 


GRITTING   THE    TEETH   AS   A   SYMPTOM    OF   WORMS 

My  baby  grits  his  teeth  terribly  when  asleep  at  night.  His 
grandmother  and  I  have  thought  he  had  worms,  and  I  have 
given  him  several  enemas  of  strong  salt  and  water,  but  I  have 
seen  nothing  that  looked  to  me  like  a  worm.  His  seat  has 
been  broken  out  and  has  itched  fearfully,  and  the  enemas  seem 
to  have  benefited  both  these  troubles;  at  least,  they  have  disap- 
peared. Of  late,  baby's  urine  has  looked  rather  greasy  on  the 
surface.  He  is  apparently  in  perfect  health,  but  has  a  very 
small  appetite,  and  would  starve  before  he  would  eat  really 
proper  food.  Whether  this  be  so  or  not,  he  seems  to  crave 
"grown-up"  food  and  digests  it  perfectly.  He  is  two  years 
and  eight  months  old,  was  nursed  till  sixteen  months,  and 
carefully  fed  till  after  two  years.  He  has  always  been  well 
and  strong,  but  not  very  fat.  Now  he  eats  almost  what  we  do, 
and  is  growing  fat  and  rosy.  The  only  trouble  he  has  is  this 
appearance  (to  me)  of  worms.  Do  you  think  we  are  right  in 
our  theory,  and  what  do  you  recommend? 

Gritting  the  teeth  in  sleep  is  not  necessarily,  or  even  usu- 
ally, a  sign  of  worms.  It  may  proceed  from  any  irrita- 
tion, very  often  in  the  digestive  tract.  If  a  child  shows  the 
condition  of  urine  you  describe,  we  should  look  for  digestive 
derangement ;  this,  added  to  the  eruption  on  the  seat  and  the 
gritting  aforesaid,  make  a  strong  probability  that  he  is  suf- 
fering, as  might  be  expected  of  a  child  of  his  age  who  takes 
"grown-up"  food.  If  he  is  put  upon  a  proper  diet,  irre- 
spective of  his  notions,  he  will  presently  yield  the  point  and 
eat  what  he  can  get.  It  is,  however,  cruel  to  expect  a  child 
who  has  been  indulged  in  this  respect  to  sit  at  the  same 
table  with  you  without  demanding  your  diet.  He  ought  to 
be  fed  before  your  meals,  and  by  himself. 

We  are  often  at  a  loss  to  guess  what  is  the  standard  of 


212       THE  CENTURY  BOOK  FOR  MOTHERS 

perfect  health  used  by  many  persons.  Your  child  is  so  de- 
scribed. Yet  you  mention  small  and  capricious  appetite, 
disordered  urine,  a  skin-eruption  and  disturbed  sleep  as  the 
sources  of  your  anxiety  about  him. 

THE   SIGNS   OF  WORMS 

My  little  girl,  aged  three  years  and  five  months,  was  taken  sick 
recently  with  severe  vomiting  and  was  very  ill  for  days.  She 
had  very  high  fever  and  coughed  a  long  time  after  recovering 
otherwise.  She  seemed  to  have  some  intestinal  catarrh. 
Though  free  from  the  diarrhoea  now,  she  complains  constantly 
at  meal-time,  and  occasionally  between-times,  of  "stomach- 
ache." She  has  very  dark  circles  under  her  eyes  and  is  very 
unusually  irritable. 

I  am  far  from  competent  physicians,  and  therefore  ask :  Can  I  do 
anything  special  in  the  line  of  tonic  treatment?  Has  she,  per- 
haps, worms?  In  the  beginning  of  her  illness  she  passed  one 
long  worm. 

To  distinguish  the  ordinary  intestinal  catarrh  from  that 
which  accompanies  intestinal  parasites,  in  default  of  the 
ocular  demonstration  of  the  worms,  is  practically  impossi- 
ble. Nor  can  one  always  say  whether  the  worms  are  the 
cause  of  the  catarrh,  or  the  catarrhal  condition  renders  the 
development  of  the  parasite  possible.  This,  too,  even  when 
the  case  is  under  observation,  since  the  classical  old- wives' 
signs  of  worms  are  really  but  symptoms  of  gastro-intestinal 
irritation.  It  is,  therefore,  impracticable  to  say  anything 
definite  about  a  case  at  a  distance.  But  the  previous  exist- 
ence of  worms,  as  demonstrated,  makes  it  rather  probable 
that,  similar  symptoms  continuing,  others  may  be  in  the 
canal.  It  would  be  entirely  proper  to  give  a  safe  vermifuge 
— such  as  two  grains  of  santonine  night  and  morning  for  a 
couple  of  days,  to  be  followed  by  a  laxative.  If  you  have 
no  drugs  at  hand,  you  may  find  that  common  salt,  a  well- 
known  vermifuge  in  Oriental  countries,  will  be  sufficient  in 
doses  of  ten  grains  given  three  or  four  times  a  day.     The 


MINOR  AILMENTS  AND   TROUBLES  213 

doses  may  be  given,  if  preferred,  by  rather  oversalting  the 
food.  It  has  the  advantage  in  these  doses  of  being  a  tonic 
to  the  digestion.  We  may  add  that  cod-liver  oil,  by  its  tonic 
effect,  tends  indirectly  to  destroy  worms. 


THE  CAUSE   OF  PIN-WORMS 

Our  baby  is  a  year  old,  and  has  always  been  very  well  and 
strong.  A  few  weeks  ago,  however,  I  found  she  was  troubled 
with  pin-worms.  I  used  injections  of  aloes,  and  they  soon 
disappeared,  but  after  a  few  weeks  returned,  and  under  the 
same  treatment  she  is  free  from  them  again.  I  would  like  to 
inquire  the  cause  of  these  little  pests,  and  if  there  is  any  way 
to  get  rid  of  them  entirely.  I  had  supposed  worms  were 
caused  by  improper  food,  but  as  baby  had  never  taken  any- 
thing besides  breast  milk,  that  idea  was  discarded. 

The  cause  of  pin-worms  is  always  the  introduction  into  the 
body  of  worms  or  their  eggs.  The  worms  may  crawl  from 
one  child  to  another,  while  the  eggs  are  obtained  in  various 
ways.  They  may  cling  to  the  finger-nails  of  another  child 
who  has  the  worms  and  who  has  been  scratching  its  seat; 
they  may  be  upon  articles  which  the  baby  has  access  to,  and 
so  on  indefinitely.  Dogs  often  are  sources  of  infection,  espe- 
cially if  they  are  allowed  to  lick  a  child's  face  or  mouth. 
AVe  cannot,  of  course,  tell  the  source  of  infection  in  the  case 
of  your  baby. 

TREATMENT   FOR   PIN-WORMS 

Will  you  please  tell  me  something  of  the  symptoms  of  pin-worms, 
and  remedies  for  this  trouble?  Is  it  very  common,  or  is  indi- 
gestion often  wrongly  called  "worms"? 

You  are  right;  indigestion  is  often  mistaken  for  ''worms," 
and  that  convenient  word  is  made  to  cover  a  wide  extent  of 
ignorance.  Intestinal  worms,  however,  are  not  uncommon, 
and  sometimes  really  are  the  cause  of  various  symptoms  of 


214  THE  CENTURY  BOOK  FOR  MOTHERS 

nervous  or  digestive  disturbance.  The  worm  which  most  com- 
monly disturbs  sleep  is  the  oxyuris  vermicularis,  commonly 
called  pin-worm,  thread-worm,  or  seat-worm.  By  day  these 
worms  usually  excite  little  disturbance,  but  at  night,  perhaps 
owing  to  the  recumbency  of  the  patient  or  the  warmth  of 
the  bed,  they  create  a  severe  itching  and  burning  of  the  seat 
which  may  disturb  or  prevent  sleep.  In  some  excitable  chil- 
dren marked  nervous  symptoms  may  ensue. 

The  treatment  consists  of  great  personal  tidiness  and  laxa- 
tives to  carry  off  the  worms.  The  itching  is  allayed  by  the 
removal  of  the  worms  from  the  seat,  and  this  is  usually 
most  readily  done  by  injections  of  soap-suds  or  of  salt  and 
water.  Olive-oil  injections  are  useful  also.  Unaffected  chil- 
dren should  not  be  allowed  to  sleep  with  affected  ones,  as 
the  parasites  may  be  communicated. 

PERSISTENT   ITCHING   OF   THE   NOSE 

Our  little  girl  of  fourteen  weeks  is  terribly  troubled  with  an 
itching  nose.  Can  you  suggest  the  cause  or  remedy?  She  is 
a  plump,  strong,  and  rosy-cheeked  baby,  and  has  never  had 
anything  but  breast  milk  until  two  weeks  ago;  at  that  time 
she  was  very  constipated,  with  curd  in  the  passages,  and  the 
physician  advised  giving  her  two  meals  per  day  of  Mellin's 
food.  She  has  five  meals,  three  hours  apart;  she  does  not 
nurse  at  night;  the  food  now  seems  well  digested,  and  she  has 
one  good  passage  a  day.  She  often  wakes  crying  and  trying 
to  rub  her  nose  on  the  blanket,  and  when  lying  on  her  side 
will  turn  over  on  her  little  face  and  rub  it  back  and  forth  on 
the  pillow.  Her  face  has  had  scratches  nearly  all  over  given 
by  the  little  fingers,  aimed  for  the  nose.  As  soon  as  it  begins 
to  itch  badly  she  wants  to  nurse  and  will  suck  her  fist  with 
great  gusto.  The  doctor  thought  it  some  kind  of  abdominal 
irritation  and  gave  her  medicine  which  does  no  perceptible 
good.  He  thinks  her  too  young  for  worms.  She  has  had  this 
trouble  ever  since  she  was  old  enough  to  make  any  attempt  to 
rub  her  nose,  perhaps  five  or  six  weeks  ago.  Do  you  think  it 
can  be  worms,  and  is  she  too  young  to  take  worm  medicine? 
She  "drools"  a  great  deal  and  bites  my  fingers  very  hard  when 


MINOR  AILMENTS  AND  TROUBLES  215 

I  wash  her  mouth,  though  there  is  no  sign  of  teeth.  I  have 
tried  every  way  I  could  think  of  to  chafe  her  nose,  using  my 
hand,  a  coarse  towel,  her  hair-brush,  etc. 

It  would  be  well  first  of  all  to  see  if  there  is  anything  in 
the  child's  apparel  that  might  cause  the  itching.  Some 
fabrics,  as,  for  instance,  the  "squirrel's-fur"  yarn,  have  a 
light  nap,  which  is  easily  detached,  and  excites,  by  being 
inhaled,  great  irritation  of  the  nose.  Still  in  this  case,  if  we 
must  hazard  an  opinion,  the  trouble  is  probably  due,  as  the 
physician  suggested,  to  some  '^abdominal  irritation."  The 
presence  of  worms  is  not  probable,  and  we  may  say  that  the 
itching  of  the  nose,  which  is  so  often  pointed  out  as  a  symp- 
tom of  worms,  is  due,  we  believe,  not  to  the  presence  of  the 
worms  themselves,  but  to  the  co-existing  intestinal  disor- 
ders. As  to  treatment,  we  would  suggest  that  the  chafing 
of  the  nose  be  done  as  little  as  possible,  but  that  soothing 
applications  be  used.  Very  weak  solutions  of  carbolic  acid 
have  been  found  useful ;  so,  too,  have  solutions  of  bicarbon- 
ate of  soda,  and  many  other  things  which  your  physician 
can  suggest.  Above  all,  persist  in  your  attempts  to  discover 
the  digestive  disorder  which  probably  lies  behind  the  irri- 
tation described. 


WHAT   TO   DO   FOR   AN   ATTACK   OF   FALSE   CROUP 

I  should  like  to  ask  what  to  do  for  my  baby  when  she  wakes  up 
at  night  with  a  cough  like  the  bark  of  the  croup.  What  do 
you  consider  to  be  the  best  and  quickest  remedy  until  the  doc- 
tor can  be  summoned  in  the  morning? 

Where  only  the  bark  is  present,  often,  and  indeed  usually, 
nothing  is  necessary  to  dislodge  the  mucus  from  the  throat 
beyond  the  waking  and  the  child's  natural  cry.  If  this  is 
not  sufficient,  the  drinking  of  a  glass  of  milk  (or  even  water), 
as  hot  as  can  be  swallowed  comfortably,  or  the  placing  of  a 
sponge  wrung  out  of  hot  w^ater— as  hot  as  can  be  borne  by 


216       THE  CENTURY  BOOK  FOR  MOTHERS 

the  child— upon  the  throat,  will  usually  relieve  it.  It  is, 
however,  well  to  have  in  the  house  an  emetic,  and  that  which 
combines  tolerable  rapidity  with  the  requisite  safety  is  the 
syrup  or  wine  of  ipecac.  If  there  is  difficulty  of  breathing, 
from  half  a  teaspoonful  to  a  teaspoonful  may  be  given,  and 
repeated  in  twenty  minutes  if  relief  is  not  gained.  If  vom- 
iting is  not  required,  doses  of  from  two  to  five  drops  may  be 
given  hourly  or  less  frequently,  according  to  the  severity  of 
the  cough. 

You  should  bear  in  mind  that  if  nausea  is  produced,  either 
mth  or  without  vomiting,  it  is  likely  to  be  manifested  by 
paleness,  clammy  skin,  and  some  perspiration,  just  as  in 
adults.  If  this  was  not  remembered,  undue  anxiety  might 
be  felt  previous  to  the  vomiting. 

THE   TREATMENT   OF   BUMPS 

My  little  boy,  two  and  a  half  years  old,  recently  fell  and  arose 
with  a  big  lump  on  his  forehead.  In  my  absence  a  neighbor 
pressed  the  swelling  down  with  the  blade  of  a  kitchen  knife, 
which  achieved  its  object  by  reducing  the  lump,  but  left  the 
spot  quite  tender  and  discolored.  I  know  that  this  way  of 
treating  a  bump  is  common  in  certain  parts  of  the  country,  but 
supposed  it  had  been  generally  superseded  by  more  enlightened 
methods.  Is  there  ever  any  danger  in  this  procedure,  and 
what  do  you  recommend  in  similar  cases? 

The  method  has  no  real  harmfulness.  The  bump  doubtless 
was  caused  simply  by  an  effusion  of  blood  from  very  small 
blood-vessels  which  had  been  broken,  together  with  some  effu- 
sion of  the  watery  part  of  the  blood  (serum)  into  the  loose 
connective  tissue.  Pressure  will  cause  absorption  of  the  lat- 
ter, but  the  discoloration  from  the  effused  blood  will  usually 
remain,  just  as  after  any  bruise.  The  tenderness  also  is  the 
rule.  Treatment  is  simple.  There  is  no  special  virtue  in  the 
table-knife  (or  a  variety  of  other  things  used  for  the  same 
purpose) ,  except  that  it  is  convenient  for  pressure  and  is  cold. 
Witness  the  ancient  remedy  of  the  door-key,  when  this  was  a 


MINOR  AILMENTS  AND  TROUBLES  217 

large  implement  of  iron,  applied  to  the  back  of  the  neck  to 
arrest  nosebleed. 

A  rather  ''more  enlightened  method"  is  to  apply  to  the 
bump  or  bruise,  by  means  of  a  sponge  or  cloth,  water  as  hot 
as  can  be  borne,  gently  pressing  it.  It  does  all  that  the  cold 
pressure  can  do,  and  is  more  effective  in  relieving  the  pres- 
ent and  preventing  the  subsequent  tenderness. 


DROWSINESS    FOLLOWING   A   BUMP   ON   THE   HEAD 

What  should  I  do  when  a  child  falls  on  the  back  of  his  head? 
Should  I  let  him  sleep  or  keep  him  awake?  My  little  boy  fell 
from  his  high  chair  a  short  time  ago,  hitting  the  back  of  his 
head  with  such  force  as  to  cause  him  to  vomit.  I  was  advised 
to  let  him  go  to  sleep  and  send  for  a  doctor,  which  I  did;  but 
baby  woke  up  after  an  hour's  sleep  quite  bright.  My  physi- 
cian says  I  should  have  kept  him  awake,  but  I  think  I  did 
right. 

What  harm  can  it  do  to  a  child  to  sleep  right  after  having  had 
such  a  fall? 

We  also  think  you  did  right.  We  do  not  know  of  any  con- 
dition due  to  an  injury  where  keeping  the  child  awake  can 
do  any  good,  whereas  sleep  is  often  a  restorative,  as  in  the 
case  of  your  child.  If  a  child  has  taken  a  narcotic  poison, 
such  as  a  preparation  of  opium  for  a  typical  instance,  the 
tendency  to  sleep  much  should  be  combated  until  the  effects 
of  the  drug  are  past.  In  such  a  case  as  you  are  describing, 
however,  the  condition  is  one  of  very  mild  concussion  of  the 
brain.  Vomiting  generally  announces  the  beginning  of  re- 
action. The  notion  that  children  who  have  had  a  fall  and 
have  bumped  the  head  severely  should  not  be  allowed  to  sleep 
is  very  common  in  popular  medicine,  but  we  do  not  remem- 
ber to  have  met  it  in  medical  circles.  It  probably  arose 
from  a  confusion  of  the  stupor  of  compression  of  the  brain, 
or  of  the  symptoms  of  the  meningitis  which  sometimes  fol- 
lows severe  injuries  to  the  head,  with  the  restorative  sleep. 


218  THE  CENTURY  BOOK  FOR  MOTHERS 

FAINTING 

What  is  to  be  done  if  a  child  suddenly  faints? 

The  child  will  probably  fall  flat  if  left  alone.  If  the  faint- 
ing is  recognized  before  this,  the  child  should  be  at  once 
laid  flat  without  a  pillow.  See  that  the  neck  is  free  and 
that  no  clothing  binds  the  waist  or  chest  in  a  way  to  hinder 
respiration.  If  signs  of  recovery  are  not  prompt,  the  limbs 
and  lower  part  of  the  body  may  be  raised,  to  cause  the  blood 
to  flow  toward  the  head.  Smelling-salts  or  common  am- 
monia may  be  held  to  the  nostrils.  Breathing  usually  starts 
pretty  promptly,  after  which  the  patient  may  generally  be 
left  undisturbed.  The  head  may  be  continued  in  the  low 
situation  until  the  patient  desires  to  change  its  posture. 

CRACKED   LIPS   AND   CHAPPED   SKIN 
Please  give  a  remedy  for  cracked  lips  and  chapped  skin. 

We  suppose  that  the  effects  of  cold  are  meant.  The  reme- 
dies are,  first  of  all,  avoidance  of  the  exposure  which  caused 
the  condition.  The  skin  and  lips  should  be  as  free  from 
moisture  as  possible,  and  after  the  necessary  washings  the 
parts  should  be  carefully  dried.  Cracked  lips,  especially 
cracks  at  the  corners  of  the  mouth,  remain  so  by  the  con- 
stant use  of  the  parts,  talking  and  laughing  often  mechan- 
ically injuring  the  points  already  inflamed,  as  well  as  ex- 
citing a  flow  of  saliva  which  irritates.  Many  applications 
are  in  common  use,  such  as  cold-cream,  camphor  ice,  etc.,  but 
we  do  not  know  that  they  are  really  better  than  simple  vase- 
line. Their  chief  value  is  to  protect  the  cracked  or  chapped 
surfaces  from  the  air. 


II 

DEFECTS  AND  BLEMISHES 

FRECKLES 

In  the  case  of  my  children  freckles  attack  both  sexes  with  equal 
impartiality,  not  sparing  even  my  little  girl  baby  of  fourteen 
months.  If  still  possible,  I  should  like  to  save  her  from  the 
fate  of  her  brothers  and  sisters.  Is  there  a  remedy?  Of 
course,  I  know  it  would  be  wrong  to  try  to  remove  freckles  by 
anything  that  might  injure  the  skin;  but  is  there  nothing 
harmless  that  could  be  used  to  advantage?  Is  it  advisable  to 
avoid  exposure  to  the  sun?  Will  broad-rimmed  hats  be  of  any 
use  in  keeping  the  fiend  off? 

Freckles  are  annoying,  and  are  often  apparently  very  dis- 
turbing to  those  who  set  much  store  by  their  complexion. 
These  peculiar  pigment  deposits  are  usually  confined  to  the 
parts  of  the  person  which  are  exposed  to  the  light— the  face 
and  hands,  namely— and  are  therefore  not  easily  concealed. 
Although  it  is  true  that  they  sometimes  appear  upon  the 
clothed  parts  of  the  body,  yet  there  is  very  good  reason  to 
believe  that  exposure  to  light  is  their  essential  cause.  They 
appear  in  summer,  when  the  hours  of  light  are  long  and 
outdoor  life  is  most  indulged  in.  Furthermore,  freckles  are 
peculiar  to  certain  complexions.  Brunettes  rarely,  if  ever, 
freckle;  they  become  tanned.  Blondes  of  the  florid  type— 
those  with  red  or  reddish  hair— are  much  more  susceptible 
to  freckles  than  others.  With  the  passing  of  summer  the 
freckles  fade  or  disappear,  and  in  winter  they  are  scarcely 
noticeable ;  as  adult  life  is  reached  they  are  less  evident  and 

219 


220  THE  CENTURY  BOOK  FOR  MOTHERS 

abundant,  independently  of  the  care  then  bestowed  upon 
the  complexion. 

The  causes  being  thus  a  peculiarity  of  complexion  and 
exposure  to  light,  it  is  impossible  to  do  much  for  them  with- 
out doing  harm  to  the  general  health.  Some  local  applica- 
tions will  temporarily  make  the  freckles  paler,  but  the  only 
real  treatment  is  prevention  by  exclusion  of  light.  This,  of 
course,  will  be  presently  destructive  of  the  health  of  the 
child.  It  is  possible  to  lessen  the  freckling,  however,  by 
avoiding  exposure  to  the  strongest  glare  of  the  sun,  and  the 
shade-hats  are  of  some  value  in  this  direction. 


A  MARK   ON   BABY'S   FACE 

Our  baby  is  now  more  than  three  months  old.  Two  or  three 
weeks  after  her  birth  a  red  mark  appeared  on  her  nose.  We 
thought  at  first  that  she  had  scratched  herself  pretty  vigor- 
ously, but  on  consulting  a  physician  a  few  weeks  later  he  pro- 
nounced it  a  "mother's  mark,"  and  advised  the  use  of  elec- 
tricity for  its  removal;  this  has  been  applied  three  times, 
and  the  redness  has  gone  from  the  middle  of  the  mark. 
Would  you  advise  us  to  continue  the  use  of  the  electricity, 
or  could  we  do  better?  We  dread  to  have  it  used,  for  it 
frightens  the  little  one  very  much,  and  must  be  painful.  Is 
it  likely  that  the  mark  would  disappear  of  itself  after  a 
while  ? 

I  have  heard  of  saliva  being  used  with  success  to  remove  marks, 
and  also  that  the  juice  of  the  milkweed  plant  is  good.  Is  it 
probable  that  either  of  these  would  accomplish  a  cure? 

There  are  ''mothers'  marks"  of  various  kinds  and  of  many 
degrees  of  severity.  Some  of  the  very  faintest  ones  we  have 
seen  fade  partly  or  wholly  without  treatment,  but  as  a  rule 
they  do  not.  As  a  mark  upon  the  face  of  a  woman  is  a  mat- 
ter of  great  concern  to  her,  every  endeavor  should  be  made 
to  get  rid  of  one,  if  it  be  of  any  importance,  before  the  age 
of  self-consciousness. 

The  saliva  is  valueless   for  the  real  ' '  mothers '  marks, ' '  and 


DEFECTS  AND  BLEMISHES  221 

SO,  too,  is  the  milkweed-juice.  Whatever  value  the  latter 
has  is  in  cases  of  the  most  superficial  kind.  In  this  case  the 
continued  use  of  the  electricity  seems  to  be  advisable. 


THE    REMOVAL   OF   A   BIRTH-MARK 

I  wish  to  consult  you  about  my  little  five-weeks-old  babe,  who 
has  been  unfortunate  enough  to  be  birth-marked  on  the  face. 
Both  eyelids  have  reddish  veins  over  them,  the  left  much 
worse  than  the  right.  Half  of  the  lid  looks  red,  and  there  is 
a  spot  of  a  darker  hue  on  the  right  nostril.  When  the  child 
is  passive  the  spots  are  dim,  but  when  active  they  become 
brighter.  They  are  not  yet  blood-red,  though  I  fear  they  will 
become  so.  As  the  complexion  clears  they  become  more  promi- 
nent.    I  would  like  to  ask: 

If  there  is  any  probability  of  their  dying  out  without  treat- 
ment? 

If  electrical  treatment  is  used  will  it  endanger  the  sight?  What 
kind  of  electricity  is  needed — galvanism?  or  would  a  faradic 
battery  do? 

At  what  age  would  it  be  best  to  commence? 

There  is  little  probability  of  their  spontaneous  disappear- 
ance. 

Not  if  properly  applied.  The  form  of  electricity  used 
in  such  cases  is  what  is  called  electrolysis,  a  needle  con- 
nected with  the  battery  being  thrust  into  the  part  to  be  de- 
stroyed. It  may  leave  a  scar.  Neither  galvanism  nor  fara- 
dism  as  ordinarily  applied  is  of  value. 

As  soon  as  the  proper  surgical  attention  can  be  secured. 


WARTS 

Will  you  tell  what  one  may  do  to  remove  warts?  My  boy,  five 
years  old,  has  nine  on  one  hand.  I  overheard  his  brother  tell- 
ing him  he  did  not  love  him  so  well  since  he  had  those  dread- 
ful things  on  his  hand.  What  does  cause  them,  and  what  will 
prevent  their  coming? 


222       THE  CENTURY  BOOK  FOR  MOTHERS 

Warts  consist  chiefly  of  an  overgrowth  of  the  papillae  of  the 
skin.  The  exciting  causes  of  this  overgrowth  are  various, 
and  often  no  cause  is  recognized.  They  are  more  likely  to 
occur  in  childhood,  probably  because  all  the  phenomena  of 
growth  are  then  more  active  than  at  other  times.  They  seem 
to  be  most  common  where  the  skin  is  most  exposed  to  all 
kinds  of  irritation,  as  upon  the  hands.  Sometimes  they  ap- 
pear to  be  communicated  from  one  person  to  another,  and 
some  persons  show  a  great  susceptibility  to  them. 

Warts  usually  appear  suddenly,  and  often  as  suddenly 
disappear.  Doubtless  upon  this  peculiarity  depends  the  ap- 
parent success  of  the  charms  and  incantations  so  commonly 
employed  for  their  removal.  It  is  possible  that  in  some  in- 
stances, where  the  charm  involved  the  rubbing  upon  the 
warts  of  the  juice  of  certain  leaves,  the  latter  may  have 
really  had  a  medicinal  influence. 

The  most  prompt  and  efficient  method  of  disposing  of 
warts  is  to  thoroughly  scrape  them  out.  This  leaves  a  little 
"punehed-out"  looking  hole  in  the  skin,  which  heals  quickly 
if  kept  clean.  If  any  bleeding  occurs  it  can  be  stopped  by 
hot  water.  This  extirpation,  if  thorough,  generally  prevents 
a  return. 

If  this  seems  too  radical  a  performance  for  domestic  medi- 
cine, the  glacial  acetic  acid  or  a  saturated  solution  of  salicy- 
lic acid  may  be  applied  carefully  to  the  wart.  The  stick 
of  a  match  or  a  piece  of  cigar-lighter  is  a  convenient  imple- 
ment for  making  the  application.  The  liquid  should  be 
applied  freely  to  the  wart,  but  not  allowed  to  flow  around. 
The  surrounding  skin  may  be  protected  by  vaseline  or  bicar- 
bonate of  soda  before  the  application.  After  a  day  or  two 
rub  off  the  dead  part  and  make  a  new  application,  and  repeat 
until  the  wart  is  gone. 


THE   BEGINNING    AND   TREATMENT   OF   STAMMERING 

My  little  boy  of  five  has,  since  his  recovery  from  a  severe  case  of 
scarlet  fever,  shown  signs  of  stammering.     He  is  sometimes 


DEFECTS  AND  BLEMISHES  223 

unable  to  express  himself  at  all,  especially  when  beginning  a 
sentence,  he  repeats  certain  words,  although  he  may  afterward 
speak  quite  well  for  hours.  How  does  one  know  whether  this 
is  a  real  case  of  stuttering?  Is  it  necessary  to  begin  treating 
him?     If  so,  what  is  the  nature  of  the  treatment? 

It  is  not  unusual  to  meet  with  cases  of  stammering  at  this 
age.  The  beginnings  may  often  be  slight,  and  scarcely  no- 
ticeable either  to  the  child  or  to  the  parents.  It  is  always 
necessary  to  take  strenuous  measures  to  prevent  a  further  de- 
velopment of  the  evil.  Usually,  the  child  will  not  outgrow  the 
trouble.  On  the  contrary,  it  is  likely  to  grow  with  the  child 's 
growth,  and  what  originally  may  have  been  but  carelessness 
is  apt  to  become  a  permanent  defect.  The  treatment  of  so 
young  a  child  calls  for  gentleness  and  calmness,  for  nothing 
is  so  likely  to  promote  stammering  as  fear  and  excitement  on 
the  part  of  the  child.  When  a  mother  perceives  that  her 
child  has  the  habit  of  repeating  syllables  or  letters,  or  of 
incorrectly  pronouncing  words  or  syllables,  she  must  not  let 
this  pass  by  unnoticed,  but  she  must  quietly  and  distinctly, 
and  without  startling  the  child  by  too  sudden  interruption, 
utter  the  wrongly  pronounced  word  or  syllable,  and  cause 
the  little  one  to  repeat  it  in  like  manner.  If  the  mother  has 
failed  to  understand  the  child,  let  her  cause  it  slowly  to 
repeat  its  words— always,  however,  without  startling  it  by 
too  sudden  or  violent  commands— and  let  her  make  it  a  rule 
never  to  comply  with  the  wish  of  a  child  which  it  has  not 
clearly  and  distinctly  uttered.  So  young  a  child  cannot, 
of  course,  be  systematically  treated,  but  he  can  be  made  to 
speak  slowly.  The  most  important  thing  is  to  accustom  him 
to  take  breath  before  he  begins  to  speak.  A  good  plan  is 
to  tell  the  child  short,  simple  stories,  pausing  in  the  re- 
cital, and  letting  him  repeat  part  after  part  slowly  and  dis- 
tinctly. Gymnastic  exercises  are,  a  little  later  on,  of  great 
value.  If  the  trouble  is  persistent,  systematic  treatment  on 
the  part  of  trained  and  conscientious  instructors  will  be 
called  for. 


224  THE  CENTURY  BOOK  FOR  MOTHERS 


LISPING 

I  am  somewhat  troubled  by  the  persistence  with  which  my  boy 
of  six  lisps.  He  pronounces  the  letter  s  invariably  as  th^  and 
my  efforts  to  correct  him  are  fruitless.  Is  he  too  young  for 
systematic  exercise  in  speaking,  and  what  course  would  you 
recommend  ? 

By  lisping  we  understand  the  false  pronunciation  of  certain 
lingual  sounds,  particularly  z  (in  zo7ie) ,  s  (in  sin),  and  c  (in 
cider).  This  defective  pronunciation  is  in  most  cases  the 
result  of  habit,  often,  however,  of  affectation,  and  is  then 
just  as  ridiculous  as  the  pronunciation  of  ?'  by  those  persons 
who  incorrectly  produce  it  by  vibration  of  the  uvula;  or  it 
arises  from  an  abnormal  formation  of  the  tongue  (too  long 
or  too  short,  too  broad  or  too  thick) .  In  the  former  case  it  is 
merely  necessary  for  the  person  to  resume  a  natural  manner 
of  speech ;  in  the  latter  the  person  must,  by  exercises  of  the 
tongue  and  practice  of  the  lingual  sounds,  be  brought  to  ap- 
proach a  correct  pronunciation. 

Th  is  a  frequently  occurring  sound  in  the  English  lan- 
guage; when,  however,  it  is  applied  where  it  does  not  be- 
long it  is  wrong,  and  is  called  lisping.  But  not  the  false 
placing  of  the  tip  of  the  tongue  alone  is  the  cause  of  lisping ; 
it  is  also  due  to  too  weak  a  pressure  of  the  tip  of  the  tongue 
on  the  palate  or  teeth,  and,  indeed,  a  careless  holding  of  the 
tip  of  the  tongue  altogether.  The  same  holds  good  of  all 
lingual  letters.  Those  afflicted  with  this  defect  must,  there- 
fore, place  the  tip  of  the  tongue  exactly  on  the  place  just 
described,  and  this  with  decision.  Those  who  are  troubled 
with  the  defect  of  lisping  must  draw  in  the  tongue,  and  the 
tip,  which  is  bent  back,  should  be  somewhat  raised.  It  is 
better,  in  exercising,  to  raise  the  tip  of  the  tongue  too  much 
at  the  outset  than  too  little ;  the  stiffness  thereby  occasioned 
w^ill  disappear  with  the  continuance  of  exercise.  As  an  exer- 
cise let  the  mother  take  the  word  zone  and  pronounce  it  to  the 
child  in  the  following  manner :  First,  pronounce  the  z  alone 


DEFECTS  AND  BLEMISHES  225 

with  a  sounding  expiration ;  keep  up  this  buzzing  tone  for  a 
time  and  then  add  on  the  one.  Let  the  child  exercise  in  this 
way  all  the  words  beginning  with  z.  Having  become  accus- 
tomed to  pronouncing  the  z  without  thrusting  the  tongue 
forward  and  out,  he  will  learn  to  pronounce  all  the  dental 
letters  correctly. 

We  do  not  think  the  child  too  young  to  begin  this  sys- 
tematic exercise,  due  care  being  observed  not  to  fatigue  or 
irritate  him. 


WANT  OF  SYMMETRY  IN  THE  FORMATION  OF  THE  HEAD 

My  little  daughter,  nearly  eight  weeks  old,  was  born  easily,  after 
what  the  competent  doctor  called  a  quick,  normal  labor.  Nei- 
ther he  nor  the  nurse  noticed  anything  out  of  the  way.  But 
since  I  have  had  entire  charge,  I  notice  that  the  right  side  of 
the  forehead  is  slightly  more  prominent  than  the  left,  and 
bulges  more  in  the  region  of  the  temple  than  is  the  case  on 
the  left  side.     The  back  bulges  also  on  the  left. 

Can  you  not  help  me  to  know  whether  the  condition  is  serious, 
although  she  gives  no  sign  of  being  unlike  any  healthy  baby? 

The  points  to  be  determined  are :  Is  the  distortion  more  than 
the  want  of  symmetry  which  is  within  normal  limits,  and  is 
it  increasing  or  diminishing?  You  would  have  saved  time 
by  asking  the  physician  who  attended  you  in  labor  if  he 
noticed  any  change.  The  commonest  cause  of  distortion  of 
the  head  is  rickets,  and  we  have  seen  the  oblique  form  de- 
pending, as  we  believed,  upon  this  peculiarity,  but  it  is  not 
often  developed  so  early.  Only  a  physician  who  has  seen 
the  child  can  give  an  opinion  worth  having. 

UMBILICAL   GROWTH 

I  have  a  little  nephew  fifteen  months  old  who  has  a  navel  rup- 
ture admitted  to  have  been  caused  at  the  time  of  his  birth.     A 
small    portion    of    what    appears    like    proud    flesh    protrudes 
slightly,  and  occasionally  bleeds  a  little.     It  constantly  exudes 
15 


226  THE  CENTURY  BOOK  FOR  MOTHERS 

a  watery  matter,  and  must  be  kept  covered  with  soft  linen, 
which  becomes  thoroughly  stained  each  day.  The  child  seems 
to  suffer  no  inconvenience  from  the  rupture,  running  and 
jumping  with  unusual  strength  for  his  age.  We  are  not  posi- 
tive that  there  is  tenderness  under  pressure.  He  is,  however, 
troublesome  to  dress  and  care  for,  and  there  is  also  a  fear  that 
the  evil  may  increase,  or  that  some  time  a  hemorrhage  may 
ensue.  A  local  physician  has  ordered  applications  of  lunar 
caustic.  Burnt  alum  and  sugar,  and  other  astringent  reme- 
dies, have  also  been  applied,  with  no  effect.  What  is  your 
advice  as  to  treatment? 

The  ailment  is  probably  not  a  rupture,  but  the  description 
corresponds  to  a  kind  of  fungous  growth  sometimes  observed 
at  the  navel.  If  astringents  fail,  as  they  seem  to  have  done 
in  this  case,  the  application  of  the  actual  cautery  (hot  iron), 
which  is  not  very  painful,  although  appalling  to  the  imagi- 
nation, generally  effects  a  cure.  The  treatment  should  be 
carried  out  by  a  competent  surgeon,  who  could  give  an  anes- 
thetic if  desirable. 


ROUND   SHOULDERS 

My  little  girl,  four  years  of  age,  is  forty  inches  tall  and  weighs 
thirty-three  pounds — a  gain  of  three  and  a  half  inches  and 
four  pounds  for  the  last  year.  She  has  always  been  tall  and 
slender,  and  from  the  time  she  began  to  walk  we  noticed  a 
tendency  to  round  shoulders — a  tendency  which  has  slowly  de- 
veloped until  it  is  now  quite  marked.  Her  father's  family, 
with  the  exception  of  her  father  himself  and  one  brother,  are 
all  very  markedly  round-shouldered,  one  case  of  it  in  the  fam- 
ily amounting  to  deformity.  I  have  tried  long  and  patiently, 
speaking  to  the  child  and  reminding  her  to  hold  herself 
straight,  but  she  never  remembers  more  than  two  seconds  at  a 
time,  and  my  efforts  result  in  flat  failure.  I  wish  to  know  if 
I  should  put  braces  on  her  this  fall,  and,  if  not,  should  I  do  so 
at  a  later  time? 

She  has  always  been  delicate  until  the  last  six  or  eight  months. 
Though  not  what  one  could  call  a  very  robust  child,  she  seems 


DEFECTS  AND  BLEMISHES  227 

perfectly  well,  has  a  fair  appetite  for  plain,  wholesome  food, 
and  an  excellent  digestion,  is  regular  in  her  habits,  and  sleeps 
soundly  and  well  from  ten  to  eleven  and  one  half  hours  out 
of  the  twenty-four. 

First,  make  sure  that  near-sight  has  nothing  to  do  with  the 
tendency  to  stoop,  although  in  so  young  a  child  it  is  not 
so  likely  to  be  the  cause  as  in  one  who  has  begun  to  use 
books.  Speaking  to  a  child  rarely,  if  ever,  does  any  good  in 
this  complaint.  The  stoop  is  not  the  result  of  desire  or  of 
indolence ;  it  is  usually  due  to  some  feebleness  of  the  muscles 
of  the  back,  which  may  indeed  be  hereditary,  as  you  seem  to 
suppose  it  to  be  in  this  case.  The  cure  is  general  strengthen- 
ing of  the  child  and  gymnastic  exercise  of  the  muscles  of  the 
back  and  shoulders,  which  she  can  get  at  a  calisthenic  class. 
If  there  is  any  spinal  trouble,  a  support  suitable  to  the  par- 
ticular case  should  be  prepared  or  selected  by  the  surgeon 
who  has  charge  of  the  case.  The  use  of  braces  depends  upon 
the  degree  of  stoop  in  the  shoulders;  if  it  is  great,  or  if  the 
exercises  do  not  diminish  it,  the  braces  are  worth  trying. 
For  directions  as  to  the  kind  needed,  you  should  consult  one 
of  the  best  surgeons  in  your  city. 

FEAR  OF   BOW-LEGS 

Our  baby  is  a  bouncing  big  one,  weighing  about  twenty-eight 
pounds  at  a  year  old.  The  subject  of  bow-legs  is  a  serious 
one  with  us,  and  consequently  we  do  not  allow  him  to  follow 
,his  inclination  to  walk.  Some  say  that  lime-water  will  pre- 
vent it,  and  the  ounce  of  prevention  is  what  we  want.  What 
do  you  advise? 

You  do  not  say  why  bow-legs  are  anticipated  by  you.  The 
commonest  cause  of  bow-legs  is  rickets— a  disease  which  is 
characterized,  in  its  full  expression,  by  deformities  of  the 
bone,  due  to  deficiency  of  phosphate  of  lime  in  the  bones,  as 
well  as  overgrowth  of  their  organic  parts.  The  lime-water 
has  been  used  very  much  as  a  remedy  for  rickets,  and  so  in- 


228       THE  CENTURY  BOOK  FOR  MOTHERS 

directly  to  prevent  bow-legs.  It  is  not  a  preventive  of  bow- 
legs, except  when  rickets  exists.  But  rickets  being  a  disease 
of  nutrition,  it  is  best  met  and  prevented  by  careful  w^atch- 
ing  in  this  direction,  and  if  any  evidences  of  the  early  stages 
of  the  malady  exist  they  should  be  attended  to  promptly 
and  the  disease  arrested.  A  child  should  be  allowed,  as  a 
rule,  to  follow  its  own  impulse  about  getting  upon  its  feet. 
It  should  not  be  placed  on  its  feet  except,  perhaps,  when 
struggling  to  get  there  of  itself.  But  when  a  child  is  able 
to  get  up  alone  it  is  very  difficult  to  hinder  it,  and  there  is 
rarely  any  reason  for  doing  so. 

REMEDIES   FOR   BOW-LEGS 

How  can  bow-legs  of  babies  be  straightened? 

Bow-legs  of  a  mild  degree  of  severity  in  infants  or  very 
young  children  sometimes  straighten  in  the  process  of  grow^th. 
Unfortunately,  only  an  experienced  physician  can  predict, 
with  any  certainty,  which  these  are.  We  should  mention 
that  in  real  babies,  as  distinct  from  running  children,  a  curve 
of  the  leg  which  is  not  abnormal  is  often  taken  by  over- 
anxious parents  for  bow-legs.  When  bow-legs  really  exist  to 
any  degree,  the  cure  is  effected  by  braces,  but  in  babies  who 
are  young  the  limbs  can  be  straightened  sometimes  by  fre- 
quent handling  by  the  mother,  her  hands  pressing  the  limb 
toward  the  desired  shape.  Even  if  braces  are  necessary,  at 
the  same  time  or  later,  the  manipulation  is  helpful. 

A   CONFIRMED   HABIT   OF   STUMBLING 

Is  there  any  remedy  but  "moral  suasion"  for  a  confirmed  habit 
of  stumbling  on  the  part  of  an  active  boy  between  five  and  six 
years  old?  There  is  no  evidence  of  weakness  in  his  legs  or 
ankles,  yet  it  is  a  very  usual  thing  for  him  to  fall  at  the 
slightest  obstacle,  like  a  projecting  paving-stone  or  any  other 
unevenness  in  the  street,  or  even  in  the  house,  like  a  door-sill. 
Severe  bruises  and  bumps  appear  to  convey  no  lesson,  and  as 


DEFECTS  AND  BLEMISHES  229 

it  seems  to  be  only  a  habit  of  extreme  carelessness  we  appeal 
to  you  to  suggest  the  best  punishment.  The  matter  was  ren- 
dered very  serious  to-day  by  a  fall,  while  running,  in  which 
our  boy  struck  his  forehead  on  a  sharp  stone,  making  two  or 
three  mutilations  which  will  probably  leave  permanent  scars, 
to  say  nothing  of  the  present  pain,  which  will  keep  him  housed 
for  nursing  for  some  days.  We  tremble  to  think  of  what  the 
consequence  would  have  been  had  the  stone  struck  his  eye 
instead. 

Differences  in  natural  agility  are  very  great.  Further, 
clumsiness  is  often  increased  by  certain  illnesses.  For  in- 
stance, some  diseases,  like  scarlatina  and  diphtheria,  which 
have  often  paralytic  sequels,  sometimes  are  followed  by  a 
certain  clumsiness  of  gait,  which  depends  upon  no  recog- 
nizable paralytic  condition.  We  can  recall  children  whose 
gait  after  such  diseases  was  strong  and  enduring,  but  whose 
feet  fell  like  hammers.  Again,  some  ailments  cause  a  dimi- 
nution of  that  harmony  of  movement  called  coordination ;  this 
is  one  of  the  results  of  phimosis.  The  harmfulness  of  phi- 
mosis has  been  much  exaggerated ;  nevertheless,  in  every  case 
of  excessive  clumsiness  in  a  boy  this  possible  cause  should 
be  inquired  into.  In  any  case,  we  should  not  think  of  pun- 
ishment to  cure  stumbling.  If  judicious  coaxing  and  '*  slow- 
ing down"  will  not  break  the  habit,  punishment  will  not, 
but  will  rather  render  the  child  more  self-conscious,  and 
therefore  more  clumsy. 

It  may  be  added  that  near-sight  or  some  other  defect  of 
vision  is  often  the  cause  of  stumbling. 

A  TONGUE-TIED   BABY 

What  shall  be  done  for  a  baby  that  is  tongue-tied?     Shall  the 
string  be  cut? 

"Tongue-tied"  means  that  the  natural  bridle  under  the 
tongue  is  so  much  shorter  than  usual  as  to  inconvenience 
the  child  in  som.e  way.     It  is  rarely  as  much  of  a  hindrance 


230  THE  CENTURY  BOOK  FOR  MOTHERS 

to  speech  as  is  supposed,  because  if  the  child's  tongue  is  free 
enough  for  it  to  suck  well,  it  is  free  enough  for  speaking. 
Occasionally,  though  rarely,  a  child  is  born  with  so  short  a 
tongue  bridle  as  to  prevent  nursing,  and  in  such  cases  cut- 
ting of  the  bridle  is  demanded.  In  other  cases  it  is  not 
really  called  for,  although  sometimes  done  in  obedience  to  a 
popular  belief.  The  cutting  is  a  trivial  matter,  if  done  by  a 
competent  person. 


CLEFT   PALATE   AND   HARELIP 

Can   the   trouble   called   "cleft   palate"    or   "harelip"   be   easily 
cured?    Are  its  symptoms  unmistakable? 

Cleft  palate  and  harelip  are  not  the  same  trouble,  but  allied 
ones.  Both  are  due  to  a  defect  of  development,  the  parts 
from  which  the  face  is  made  up  not  being  completely  fused. 
Harelip  is  more  frequent  than  cleft  palate.  It  may  occur  in 
one  or  both  sides,  the  splits  in  the  lip  being  below  the  nos- 
trils, never  in  the  middle.  The  cleft  palate  may  involve  the 
soft  palate,  or  the  hard  palate  as  well.  Harelip  can  gener- 
ally be  cured  by  an  operation  of  no  great  difficulty,  although 
involving  some  nicety  to  obtain  the  most  satisfactory  results. 
The  operation  for  cleft  palate  is  more  difficult,  but  usually 
quite  successful.     It  can  be  cured  only  by  operation. 

There  are  no  symptoms  in  the  ordinary  sense  of  that  word. 
There  is  a  very  evident  physical  defect.  If  the  defect  be  so 
great  as  to  interfere  with  nursing,  nutrition  is  difficult,  and 
in  one  sense  the  symptoms  of  the  resulting  inanition  might 
be  attributed  to  the  causative  defect. 


"WHOPPER-JAW" 

My  baby  is  now  over  ten  months  old.  She  has  cut  the  upper 
and  lower  central  incisors,  and  is  now  getting  the  lateral  in- 
cisors. The  under  teeth  shut  over  the  upper  ones.  Is  there 
any  danger  of  her  being  "whopper- jawed"  when  she  has  all 


DEFECTS  AND  BLEMISHES  231 

her  teeth?  If  so,  can  anything  be  done  to  prevent  it?  Her 
mouth  when  closed  appears  perfect,  though  the  teeth  are  as  I 
have  described. 

The  projection  of  the  under  jaw,  rather  than  of  the  teeth 
themselves,  usually  causes  the  condition  of  'Svhopper-jaw," 
and  it  is  doubtful  whether  it  can  be  artificially  modified.  If 
the  condition  continues  and  appears  dependent  upon  the 
teeth,  your  dentist  can  tell  you  if  their  position  can  be  rec- 
tified. 

DEAF-MUTISM 

What  would  you  think  of  a  child  nearly  three  years  old  who  did 
not  say  a  single  word?  I  do  not  mean  one  who  has  a  lan- 
guage of  his  own,  unintelligible  to  others,  the  simple  fact 
being  that  he  does  not  attempt  to  utter  a  word,  and  it  is  very 
hard  to  see  that  he  comprehends  when  spoken  to.  I  have  in 
mind  a  little  fellow  who  is  causing  us  much  anxiety  on  ac- 
count of  his  backwardness  about  talking,  or  rather  of  his  not 
speaking.     What  would  you  advise? 

Such  a  child  should  be  first  of  all  examined  for  deaf -mutism, 
and,  if  it  hears  well,  some  one  familiar  with  such  matters 
should  inquire  into  its  intelligence.  In  order  to  ascertain 
w^hether  the  child  hears,  the  aurist  relies  upon  the  tuning- 
fork,  whistle,  and  bell,  or  instruments  producing  noises  of  a 
similar  character.  In  applying  any  of  these  tests  it  is  neces- 
sary to  be  on  one's  guard,  and  exclude  the  possibility  of 
the  child  having  its  attention  called  to  the  various  testing- 
objects  by  senses  other  than  that  of  hearing.  For  instance, 
the  mother  may  test  with  a  whistle ;  the  child  turns  at  once, 
and  she  reasons  that  it  has  heard  the  sound.  This,  how- 
ever, may  not  have  been  the  case ;  the  blast  of  air  leaving  the 
whistle  may  have  impinged  upon  the  child's  face,  and  this 
may  have  caused  it  to  turn  around.  In  like  manner,  a  child 
may  turn  because  it  feels  the  vibrations  transmitted  by  the 
floor,  following  the  violent  closure  of  a  door ;  yet  this  action 


232  THE  CENTURY  BOOK  FOR  MOTHERS 

on  the  part  of  the  child  may  be  wrongfully  attributed  to  its 
having  heard  the  noise. 

An  important  peculiarity  of  deaf-mutes,  though  not  in 
itself  an  absolute  proof,  is  their  manner  of  expressing  their 
desires  through  gestures,  and  their  impatience  and  anger 
when  not  understood  at  once.  One  of  the  most  important 
signs,  of  course,  is  the  fact  that  the  child  does  not  begin  to 
talk  when  it  should.  No  mother  should  accept  the  verdict 
of  deaf-mutism  until  such  an  opinion  has  been  given  by  a 
competent  aurist,  after  he  has  examined  the  child's  ears.  A 
child  may,  as  a  result  of  being  born  so,  or  as  the  consequence 
of  disease  of  the  ear  after  birth,  whether  this  has  been  no- 
ticed or  not,  be  very  hard  of  hearing,  and  yet  not  be  abso- 
lutely deaf.  If  nothing  be  done  for  such  a  child,  its  deaf- 
ness becomes  worse  from  disuse  of  the  organ  of  hearing,  and 
finally  may  become  absolute,  while  if  proper  training  and 
treatment  had  been  instituted  in  such  a  case,  some  ameliora- 
tion of  the  defect  might  have  been  achieved. 


Ill 

COLDS  AND  CATARRH 

FRESH   AIR   AND   COLDS 

I  would  like  to  know  if  a  child  six  months  old  that  has  not  been 
out  of  the  house  for  many  weeks  ought,  in  your  opinion,  to  be 
taken  out  during  the  winter  on  moderately  pleasant  days.  The 
child  is  not  very  large  or  strong  for  her  age,  and  is  raised  on 
the  bottle;  she  discharges  from  the  nose  as  if  she  had  a  cold 
most  of  the  time. 

The  facts  given  are  too  few  to  enable  us  to  answer  defi- 
nitely, but  from  the  following  general  remarks  you  may  be 
able  to  make  an  application  to  your  baby's  case:  In  the 
first  place,  we  do  not  believe  in  taking  out  children  in  all 
kinds  of  weather  regardless  of  consequences,  which  is  a  part 
of  the  senseless  ''hardening"  theory.  The  safe  rule  is,  we 
think,  this:  Children  ought  to  be  regularly  sent  out,  except 
when  there  is  rain  or  when,  by  reason  of  great  cold  and 
very  high  wind,  they  cannot  be  kept  comfortable.  On  such 
days  we  believe  in  the  value  of  a  promenade,  the  child 
dressed  as  for  an  out-door  walk,  in  a  room  which  has  been 
thoroughly  opened  to  the  air.  In  this  way  it  can  get  some- 
thing of  a  change  without  exposure.  But  there  are  some 
children  who  do  not  seem  to  do  well  if  allowed  to  go  out  of 
doors  on  any  but  the  "bright  and  airless"  days.  This  is 
particularly  noticeable  in  the  city  when  the  streets  are  loaded 
with  mud  and  slush,  and  we  think  evil  effects  are  more  no- 
ticeable in  children  who  are  old  enough  to  walk  than  in 

233 


234       THE  CENTURY  BOOK  FOR  MOTHERS 

infants.  This  may  be  attributed  to  the  inactivity  of  the 
children  who  walk  slowly  along  on  the  sidewalks  or  are 
obliged  to  stand  at  street  corners  while  a  conversation  is  car- 
ried on  by  those  in  charge.  The  children  whose  animal 
spirits  lead  them  into  continuous  romping  out  of  doors  suf- 
fer less.  Be  the  cause  what  it  may,  some  children,  as  we 
have  said,  do  not  well  endure  their  daily  walk,  and  are  in 
less  frequent  need  of  medical  advice  when  kept  in  on  all  but 
very  fine  days.  Going  out  seems  to  keep  them  supplied  with 
''colds"  and  other  little  ailments.  But  before  the  attempt 
to  take  the  child  out  is  given  up  one  should  make  sure  that 
the  attendant  inconveniences  are  unavoidable.  If  there  were 
not  so  frequent  an  assumption  to  the  contrary,  it  would  be 
unnecessary  to  say  that  there  is  no  deleterious  element  in 
out-door  air  that  is  not  in  in-door  air;  our  in-door  supply 
must  come  from  without,  and  we  certainly  do  not  purify  it 
in  our  dwellings.  What  we  do  avoid  indoors  is  a  too  low 
temperature  and  the  violent  force  of  winds  and,  to  some 
extent,  the  all-pervading  dust. 

If  possible,  let  the  child  be  carried.  Your  six-months' 
baby  probably  could  be;  this  gives  her  the  warmth  of  the 
arms  of  the  person  carrying  her.  But  see  to  it  that  she  is 
w^ell  protected  everywhere,  not  only  about  the  head  and 
trunk,  but  about  the  legs.  Many  a  little  child  we  meet  whose 
legs  protrude  helplessly  from  its  finery.  If  the  child  is  in 
long  clothes,  let  them  be  not  too  fine  to  be  doubled  up  or 
folded  around  the  legs.  They  are  for  warmth,  not  for  deco- 
rative art.  If  it  has  reached  the  age  of  short  clothes,  and  is 
to  be  carried,  we  prefer  to  knitted  leggings,  with  the  shoes 
protruding,  a  petticoat  of  short  flannel  or  a  blanket,  sewed 
up  at  the  bottom  like  the  sleeping-bag  of  camp-life.  This 
keeps  the  feet  warm,  while  allowing  the  legs  freedom  of 
motion. 

A  word  as  to  the  ''cold."  This  term  is  so  fixed  in  our 
speech  that  it  is  useless  to  quarrel  with  it.  It  is  only  neces- 
sary to  mention  here  that  the  symptoms  are  not  always,  and 
perhaps  not  usually,  due  to  the  chilling  of  the  person.     And 


COLDS  AND  CATARRH  235 

when  the  trouble  is  persistent,  as  in  the  present  case,  this  is 
almost  certainly  not  the  cause.  There  may  be  a  local  cause 
in  the  nose,  or  the  trouble  may  depend  upon  the  feebleness 
of  constitution  of  which  you  speak.  Perhaps  this  feebleness 
is  to  some  extent  kept  up  by  the  child's  lack  of  fresh  air.  At 
all  events  the  cause  of  the  discharge  ought  to  be  inquired  into. 

COMPREHENSIVE   QUESTIONS   CONCERNING 
COUGHS  AND   COLDS 

Please  give  me  some  simple  home  remedies  for  tight  cough,  loose 
cough,  head  cold,  with  running  at  nose,  cold  on  the  lungs, 
hoarse  cold — always  understanding  that  if  sufficient  relief  is 
not  obtained  a  physician  will  be  consulted. 

The  various  ailments  you  ask  remedies  for  are  usually  sim- 
ply different  stages  or  manifestations  of  the  same  thing— 
namely,  a  catarrhal  inflammation  of  the  mucous  membrane 
of  the  air-passages.  A  ''cold"  may  go  through  the  whole 
range,  or  it  may  be  confined  to  or  chiefly  manifested  in  some 
particular  parts  of  the  passages.  A  typical  bronchitis,  for 
instance,  begins  with  a  ''nose  cold,"  or  coryza.  The  irrita- 
tion quickly  attacks  the  larynx,  causing  a  "hoarse  cold," 
laryngitis,  which  may  be  attended  in  some  children  with  the 
symptoms  of  false  croup.  It  then  passes  into  the  windpipe 
(trachea)  and  the  larger  bronchi,  making  a  bronchitis.  In 
the  first  congestion,  the  cough  is  "tight,"  and  there  is  a 
sense  of  constriction;  later,  as  the  mucous  membrane  begins 
to  secrete  freely,  and  the  discharge  increases,  it  is  said  to  be 
"loose."  To  the  physician,  the  whole  procession  of  events 
is  one  malady,  and  he  would  probably  attack  it  as  such,  if 
he  had  the  opportunity,  in  the  beginning.  Usually,  how- 
ever, the  catarrh  is  well  established  before  he  is  called  (if  at 
all),  and  he  must  then  simply  give  remedies  to  ease  this  or 
that  symptom,  and  to  try  to  abbreviate  the  course  of  the 
"cold,"  which,  let  alone,  would  usually,  from  beginning  to 
end,  cover  about  a  fortnight.  It  should  be  noted  (although 
we  cannot  here  discuss  it)   that  "colds"  are  not,  by  any 


236  THE  CENTURY  BOOK  FOR  MOTHERS 

means,  the  same  thing  in  all  cases.  The  ''prevailing  colds'^ 
are  probably  due  to  some  special  poison,  affecting  many  peo- 
ple at  once  in  a  way  similar  to  that  in  which  the  now  very 
familiar  disease  "influenza"  or  "la  grippe"  attacks  a  com- 
munity. There  are,  however,  some  real  "colds,"  due  to 
effects  of  change  of  temperature.  Thus,  some  persons  can- 
not sit  in  a  draft  without  experiencing  subsequent  pain  and 
stiffness  in  the  exposed  parts.  Persons  whose  naso-pharyn- 
geal  mucous  membrane  is  not  in  sound  condition  are  always 
catching  cold — i.  e.,  having  slight  exacerbations  of  their  ordi- 
nary catarrhal  condition,  which  they  may  be  so  accustomed 
to  as  not  to  recognize  it  in  its  true  light. 

For  the  relief  of  symptoms,  then,  changing  the  order  of 
your  questions,  the  head  cold  may  be  treated  with  local  ap- 
plications, such  as  steam  of  hot  water,  when  the  sneezing 
and  other  signs  of  irritation  first  appear,  and  sprays  of  some 
safe  antiseptic,  such  as  "listerine,"  diluted  with  five  to  ten 
times  its  bulk  of  water,  after  the  discharge  is  established. 
Internally,  a  great  many  remedies  have  had  repute.  One 
much  used  is  the  so-called  "rhinitis  pill"  (rhinitis  meaning 
inflammation  of  the  nose),  which  contains  quinine,  camphor, 
and  belladonna  in  small  amounts. 

The  hoarse  cold  is  chiefly  important  from  the  possibility 
of  an  attack  of  croup.  So  far  as  domestic  treatment  is  con- 
cerned, the  remedies  before  mentioned  are  about  as  good  as 
any,  noting  that  steam  is  especially  useful,  as  being  more 
easily  applicable.  Sometimes  comfort  is  obtained  by  the 
use  of  soothing  mixtures,  known  to  physicians  as  "demul- 
cents," such  as  flaxseed  tea,  or  elm-bark  tea,  and  the  like, 
and,  w^hat  is  particularly  acceptable  to  the  childish  palate, 
the  mixture  of  butter  and  molasses  cooked  into  a  viscid  mass, 
popularly  called  "stewed  Quaker." 

The  "cold  on  the  lungs"  probably  is  intended  to  mean 
bronchitis,  as  described  above.  The  fault  of  domestic  diag- 
nosis is  that  it  has  no  means  of  distinguishing  from  ordinary 
bronchitis  pneumonia  or  pleurisy,  which  have  cough,— the 
latter  often  a  peculiarly  "tight"  and  painful  one.     Leaving 


COLDS  AND  CATARRH  237 

this  aside,  we  may  say  that  the  domestic  remedies  suitable  to 
the  "tight"  stage  are  simply  those  which  allay  irritation 
and  favor  the  flow  of  the  bronchial  secretion.  For  the  for- 
mer, opium  in  small  doses  is  very  useful,  hence  the  repute 
of  paregoric  and  Dover's  powder.  In  the  former  the  opium 
is  combined  with  camphor,  in  the  latter  with  ipecac.  Of 
medicines  promoting  bronchial  secretions,  or  expectorants, 
ipecac  and  squills  are  familiar  examples,  the  former  being 
preferable  for  nursery  use.  When  a  cough  is  loose — i.  e.y 
when  the  secretion  is  already  sufficiently  free— it  is  doubtful 
if  any  drugs  proper  for  domestic  administration  are  desir- 
able, beyond  the  simplest  soothing  mixtures,  the  ''demul- 
cents" spoken  of  before.  Tonics  and  remedies  conducive  to 
hastening  convalescence  are  useful,  but  not  within  the  proper 
range  of  household  medicine. 

TREATMENT   OF   A  "HARD   COLD" 

What  is  the  proper  management  of  a  hard  cold  in  the  case  of  an 
eighteen-months-old  child?  It  has  made  him  exceedingly  ner- 
vous, and  his  naps  are  much  disturbed  by  coughing.  The  cold 
is  in  his  head,  but  I  keep  throat  and  chest  well  oiled,  and 
have  given  no  medicine. 

The  medicinal  treatment  of  a  "hard  cold"  we  cannot  give 
you,  because  the  phrase  has  no  definite  meaning,  and  if  there 
be  any  need  of  medicinal  treatment  at  all,  it  is  not  domestic 
treatment  alone.  In  your  child's  case,  in  this  particular  in- 
stance, the  ' '  hard  cold ' '  seems  to  mean  a  bronchitis,  with  the 
usual  acute  nasal  catarrh,  sufficiently  severe  to  disturb  his 
sleep  by  obstruction  to  his  breathing.  The  cough,  probably 
bronchial,  increases  the  disturbance.  The  nursing  of  such 
a  case  consists  in  keeping  the  child  warm  enough,  but  not 
burdened  with  clothing,  in  moderately  warm  but  not  stuffy 
air,  in  giving  light  diet,  and  keeping  the  bowels  free.  The 
oiling  of  the  chest  is  harmless ;  we  cannot  say  that  it  is  defi- 
nitely curative,  unless  the  oil  contains  some  slightly  irritating 
substance,  such  as  camphor  or  a  little  turpentine. 


238  THE  CENTURY  BOOK  FOR  MOTHERS 

CAUSES   AND   TREATMENT   OF   CATARRH 

I  have  four  little  girls  who  are,  respectively,  seven,  five,  three,  and 
one  year  old.  With  each  approach  of  winter  and  more  or  less 
all  through  they  are  troubled  with  catarrh,  earache,  and  croup- 
ous cough.  We  have  a  comfortable  new  home,  deep  water,  nat- 
ural gas  in  the  kitchen,  and  wood  fire  in  the  nursery.  We  live 
in  the  country,  within  three  minutes'  walk  of  the  church  or 
school.     This  catarrhal  tendency  is  inherited  from  the  mother. 

Which  would  you  advise — to  try  a  local  remedy?  If  so,  what? 
Or  to  move  to  a  warmer  climate?     If  so,  where? 

It  would  appear  that  your  surroundings  are  satisfactory 
and  not  responsible  for  the  catarrhal  tendency.  Such  a  ten- 
dency undoubtedly  is  caused  by  or  aggravated  by  heredity, 
but  very  much  also  depends  upon  exciting  causes.  Let  us 
take  up  the  conditions,  as  you  put  them:  Catarrh— that  is, 
nasal  or  throat  catarrh;  earache,  doubtless  dependent  upon 
extension  of  the  catarrhal  inflammation  from  the  throat 
through  the  Eustachian  tube  to  the  middle  ear;  croupy 
cough,  dependent  upon  a  catarrhal  laryngitis,  also  usually  an 
extension  from  the  pharynx.  So  the  whole  comes  back  to 
the  nose  or  throat  catarrh.  Now,  the  commonest  cause  of  this 
trouble  in  its  chronic  or  recurring  form  is  an  enlargement  of 
the  glandular  body  in  the  posterior  nasal  cavity,  known  as  the 
'Hhird  tonsil"  or  as  an  "adenoid."  Catarrhal  conditions  ex- 
ist with  any  such  enlargement,  but  if  the  latter  be  present, 
success  in  treatment  of  the  catarrh  will  hardly  be  gained 
without  the  removal  of  this  mass.  Such  removal  is  the  first 
and  most  efficient  local  remedy.  We  cannot  tell  you  how  to 
find  out  the  exact  causes  of  the  trouble  for  yourself.  A  physi- 
cian familiar  wdth  the  proper  state  of  the  nasal  cavities  can 
tell  by  the  use  of  his  finger  whether  any  such  obstruction 
exists.  Its  removal  should  be  effected  by  him  if  he  be  famil- 
iar with  the  operation. 

If  no  enlargement  exists,  or  after  it  has  been  removed,  a 
good  deal  can  be  done  by  local  applications.  Any  good 
cleansing  spray  will  do  good,  but  we  do  not  lay  stress  upon 


COLDS  AND  CATARRH  239 

that  until  the  prime  question  of  the  growth  in  the  nasal 
cavities  is  settled.  As  you  have  evidently  considered  the 
need  of  removal  of  your  home,  you  doubtless  would  be  still 
more  ready  to  make  a  journey  for  treatment— if  you  cannot 
find  what  you  need  at  home— to  a  city  where  good  medical 
advice  can  be  obtained. 

One  or  two  things  else  may  be  mentioned.  Where  the 
catarrh  depends  upon  inherited  weakness,  as  you  think  it 
does  in  the  case  of  your  children,  usually  a  good  deal  is 
gained  by  the  persistent  use  of  cod-liver  oil  through  the  cool 
months.  Again,  a  good  many  of  the  existing  causes  of  ca- 
tarrhal attacks  may  be  prevented  by  strict  attention  to  dress 
and  general  hygiene. 

THE   COMMUNICABILITY   OF   CATARRH 

Will  you  kindly  inform  me  if  there  is  any  danger  in  a  person 
caring  for  an  infant  who  has  catarrh  of  the  head? 

We  suppose  you  mean,  Is  there  danger  to  the  attendant  ?  and 
that  by  catarrh  you  mean  an  ordinary  chronic  catarrhal  dis- 
charge from  the  nose.  We  particularize  because  the  popular 
use  of  the  word  catarrh  covers  a  variety  of  disorders,  from  an 
ordinary  fresh  "cold  in  the  head"  to  special  diseases  of  the 
nasal  cavities.  But  taking  the  question  to  mean  what  we  have 
above  supposed,  we  should  say  that  there  was  no  danger  to 
the  attendant.  If  you  mean.  Is  there  danger  to  the  infant 
if  the  attendant  has  nasal  catarrh?  we  should  say  that  it 
would  depend  upon  the  kind  of  "catarrh."  These  acute 
colds  in  the  head  seem  to  be  communicable.  Ordinary 
chronic  nasal  catarrhs  seem  not  to  be,  while  there  are  occa- 
sional cases  of  quite  another  kind  which  should  be  guarded 
against. 

CARE   OF  A   SENSITIVE   THROAT 

My  baby  of  two  years  has,  I  fear,  a  delicacy  of  the  throat.  Her 
voice  will  become  quite  hoarse  after  a  few  minutes'  exposure 
to  damp  air,  and  without  any  other  sign  of  a  "cold."     She  has 


240        THE  CENTURY  BOOK  FOR  MOTHERS 

now  been  very  hoarse  for  a  week.  Occasionally,  in  taking  her 
up  in  the  morning,  I  can  detect  a  slight  odor  of  mucus. 

I  have  given  no  medicines.  She  rarely  has  a  "'cold."  So  far  I 
have  only  been  careful  in  protecting  her  feet  from  damp 
ground,  and  in  keeping  on  her  a  light-weight  woolen  shirt.  Is 
there  anything  further  that  I  can  do,  and  do  you  think  she 
will  outgrow  the  tendency? 

I  ought  to  mention  that  last  winter  she  had  bronchial  pneumonia, 
her  only  illness,  but  as  she  apparently  recovered  without  any 
weakness,  and  this  hoarseness  dates  back  to  last  summer,  I 
have  not  considered  the  illness  responsible  for  her  present  con- 
dition. 

It  is  difficult  to  really  treat  the  throat  of  a  child  of  two  years, 
but  something  may  be  done.  Apparently  the  child  has  a 
nasal  catarrh,  the  mucous  membrane  being  easily  affected 
by  damp  air.  For  the  present  we  think  it  wise  to  try  to 
teach  her  to  let  you  cleanse  the  nose  and  throat  with  a  spray. 
The  reasons  for  this  are  that  cleansing  the  mucous  membrane 
tends  to  improve  its  condition,  and,  above  all,  prevents 
various  organisms  from  making  their  home  there  and  then 
setting  up  the  more  serious  throat  diseases. 


TAKING   COLD   EASILY 

My  baby,  nearly  two  years  old,  takes  cold  very  easily,  I  never 
know  how.  She  perspires  on  slight  cause.  When  asleep,  with 
only  a  little  covering,  her  head  will  very  soon  be  wet.  Her 
feet,  too,  perspire  easily;  in  fact,  her  stockings  are  almost  al- 
ways damp  and  her  feet  often  cold.  Of  course  I  know  she 
needs  some  constitutional  remedy  for  this,  and  I  do  use  some- 
thing when  she  is  not  taking  other  medicine  for  a  cold,  but  is 
there  anything  I  can  do  locally? 

The  two  symptoms  mentioned,  sweating  of  the  head  and 
taking  cold  easily,  are  suggestive  of  that  form  of  malnutri- 
tion knoAvn  as  rachitis,  or  rickets.  If  this  exists,  the  remedy 
lies  in  nutritious  and  digestible  food,  cool  sponging  of  the 


COLDS  AND  CATARRH  241 

skin,  and  whatever  else  goes  to  make  up  sound  hygiene. 
Sometimes  tonics  are  needed.  But  the  preventing  of  the 
colds  by  proper  hygiene  is  far  better  than  dosing  for  them. 


COLD   IN   THE   HEAD;    APPLICATION  OF   VASELINE 

My  baby  is  almost  nine  months  old  and  weighs  about  twenty 
pounds,  exclusive  of  clothing.  She  seems  strong  and  active, 
but  has  had  two  or  three  troublesome  head  colds  and  is  inclined 
to  constipation.  She  has  two  teeth,  which  were  cut  without 
any  trouble,  is  fed  entirely  from  the  breast,  and  usually  takes 
six  meals  during  the  twenty-four  hours. 

Our  house  is  quite  "drafty,"  so  that  baby  is  kept  a  good  deal 
in  her  high  chair  and  carriage.  Ought  she  to  exercise  on  the 
floor? 

Is  there  anything  to  do  for  a  cold  in  the  head  except  to  apply 
vaseline  about  the  nose  and  forehead? 

It  is  not  necessary  for  her  to  be  on  the  floor,  but  she 
should  have  opportunity  to  use  her  limbs.  The  high  chair 
is  confining;  the  carriage  is  better.  Why  not  let  her  play 
upon  a  bed  with  sides  to  keep  her  from  falling  off,  which 
would  be  still  better? 

Various  solutions  can  be  used  in  the  form  of  spray  from 
an  atomizer.  But  you  would  better  not  select  the  solu- 
tion without  medical  advice.  The  vaseline  should  be  used 
in  the  nose,  rather  than  around  it.  Warm  it,  and  if  you 
have  no  suitable  atomizer,  put  it  into  the  nostril  with  a  soft 
camel's-hair  brush  or  by  dropping  in  a  little. 


"STARVING  A   COLD" 

You  would  oblige  me  if  you  would  state  whether  a  young  child 
having  a  cold  should  be  kept  on  a  very  plain  diet  while  the 
cold  lasts.  Do  you  believe  in  what  is  commonly  called  "starv- 
ing a  cold"  ?  My  little  five-year-old  niece  has  been  coughing 
for  some  time  and  looks  pale,  yet  she  is  generally  contented 
and  happy.  Would  it  be  best  to  give  her  gruel,  milk  and 
16 


242       THE  CENTURY  BOOK  FOR  MOTHERS 

water,   etc.,   and  but  very  little  meat,   while  the   cold  lasts? 
Should  she  be  kept  very  quiet  aud  sleep  as  much  as  possible? 

The  proverb  from  which  our  correspondent  quotes  is  quite 
as  often  reversed;  indeed,  we  first  learned  it,  ^^ stuff  a  cold 
and  starve  a  fever."  The  question,  as  specifically  put,  is 
also  too  vague  to  be  answered  categorically,  since  so  many 
ailments  go  under  the  name  of  "a  cold."  But  we  may  an- 
swer in  a  general  way  thus:  This  child  has  been  coughing 
for  some  time,  and  has  probably  a  catarrh  of  the  throat  or 
windpipe.  She  is  somewhat  depressed  by  it,  as  shown  by  her 
paleness.  As  far,  then,  as  the  diet  needs  supervision,  it 
should  be  for  the  purpose  of  securing  good  nutrition  with 
easy  digestion.  The  milk,  if  good,  answers  both  indications. 
The  gruels,  if  milk- gruels,  are  also  useful.  If  she  can  easily 
digest  a  little  meat  in  the  early  part  of  the  day,  it  may  be 
allowed,  but  it  will  not  be  needed  if  plenty  of  milk  be  taken. 
Good,  nutritious  broths,  not  greasy,  are  also  good ;  so  some- 
times are  fresh  eggs.  It  will  be  noticed  that  while  the  food 
in  question  is  ''light"  in  the  sense  of  liquid,  it  is  exceed- 
ingly nutritious,  and  that  it  gives  no  indorsement  at  all  of 
any  starvation  theory.  Great  confusion  exists  popularly  as 
to  what  is  nutritious  diet.  Much  food  that  would  be  very 
nutritious  to  a  robust  adult  digestion  is  only  wasted  and  irri- 
tating when  put  into  a  stomach  that  cannot  manage  it. 


IV 

WHOOPING-COUGH 

THE   FIRST   SYMPTOMS   OF  WHOOPING-COUGH 

Can  you  tell  me  what  are  the  first  symptoms  of  whooping-cough? 
Do  they  differ  in  any  way  from  those  of  an  ordinary  cold  and 
cough  ? 

The  first  stage  of  whooping-cough  presents  symptoms  of  a 
catarrh  of  the  upper  air-passages  and  bronchitis  which  has 
nothing  to  distinguish  it  from  an  ordinary  inflammation  of 
these  parts.  There  is  sneezing,  with  some  suffusion  of  the 
eyes  and  running  at  the  nose,  but  less  than  is  seen  with  mea- 
sles. The  cough  is  accompanied  by  very  little,  if  any,  expec- 
toration. After  these  symptoms  have  lasted  from  one  to  two 
weeks,  it  is  noticed  that  the  cough  becomes  severer  and  as- 
sumes a  spasmodic  character.  The  cough  is  worse  at  night, 
and  whenever  the  child  becomes  excited  from  any  cause.  It 
takes  place  entirely  in  paroxysms,  between  which  the  child 
is  perfectly  well.  A  paroxysm  begins  with  a  tickling  sensa- 
tion or  a  feeling  of  constriction  in  the  throat.  It  consists  of 
a  series  of  expirations  which  expel  much  of  the  air  in  the 
lungs,  followed  by  a  quick  inspiration  that  produces  the 
sound  known  as  the  ''whoop."  When  children  begin  to 
vomit  in  connection  with  fits  of  coughing,  we  can  be  suspi- 
cious of  whooping-cough,  even  if  the  ''whoop"  has  not 
occurred. 

243 


244  THE  CENTURY  BOOK  FOR  MOTHERS 

SUPPOSED   IGNORANCE   OF   PHYSICIANS   CONCERNING 
WHOOPING-COUGH 

Two  of  my  children,  one  two  years  old  and  the  other  five,  have 
had  whooping-cough  rather  mildly  for  the  last  two  months, 
but  I  think  they  are  on  the  mend.  What  would  improve  their 
ease? 

I  regret  to  say  that  the  medical  faculty  do  not  seem  to  know 
much  more  about  it  than  was  known  fifty  years  ago. 

Whooping-cough  is  a  disease,  if  not  of  fixed,  at  least  of  pro- 
longed, course.  The  ''medical  faculty"  knov^^  a  great  deal 
more  about  it  than  they  did  fifty  years  ago.  But  medical 
science  usually  does  not,  and  we  suspect  will  not,  abbreviate 
the  course  of  diseases  of  an  infectious  nature  after  they  are 
well  begun.  What  has  been  accomplished  in  many  of  them 
is  this:  To  recognize  their  natural  career,  the  accidents 
and  dangerous  complications  attending  them;  to  point  out 
the  best  means  of  avoiding  or  treating  the  latter,  and 
of  mitigating  symptoms  and  hastening  convalescence.  Most 
of  all,  science  has  pointed  out  means  of  avoiding  con- 
tagion. 

Now,  as  to  the  particular  cases  in  hand.  The  children  are 
mending,  and  in  all  probability  will  soon  be  cured.  But 
we  can  offer  you  a  few  hints  which  may  be  serviceable. 
First  of  all,  winter  is  coming,  and  in  your  climate  will  come 
soon.  It  is  very  desirable  not  to  enter  the  cold  season  with 
the  bronchitis  of  whooping-cough  still  lingering,  because  of 
its  tendency  to  exacerbations  and  to  chest  complications. 
See  to  it,  therefore,  that  your  little  ones  are  properly  clothed 
from  throat  to  foot,  evenly,  warmly,  but  not  burdensomely. 
Try  to  keep  your  indoor  temperature  moderate  (not  above 
70  degrees,  preferably  nearer  65),  and  as  uniform  as  pos- 
sible. Regulate  their  outdoor  clothing  each  day  by  the  ther- 
mometer, which  will  probably  vary  a  good  deal  in  the 
coming  months.  Try  to  teach  the  habit  of  breathing  through 
the  nostrils,  as  mouth-breathing  is  likely  to  excite  cough  in 

A  SPECIMEN  PAGE  OF  THE  BOOK. 


WHOOPING-COUGH  245 

children  recovering  from  whooping-cough.  Many  little  de- 
tails will  occur  to  you  for  which  we  have  not  space. 

Secondly,  attend  to  the  diet  and  to  the  digestion,  as  any 
derangement  of  the  stomach  aggravates  the  tendency  to 
cough  and  to  recurrences.  If  there  is  any  marked  digestive 
trouble,  medicinal  remedies  will  be  needed— tonics,  sto- 
machics, etc.,  according  to  the  nature  of  the  derangement. 

Beyond  these  points  we  need  not  specify,  except  that  abun- 
dant and  pure  air  in  or  out  of  doors  is  always  a  tonic.  By 
pure  air  we  do  not  mean  harsh  air,  nor  gales  of  wind,  which 
may  bring  anything  but  purity  with  them. 


CONTAGION  OF  WHOOPING-COUGH 

Can  whooping-cough  be  carried  from  one  child  to  another  with- 
out the  two  children  being  together?  At  what  time  in  the 
duration  of  whooping-cough  does  one  child  give  it  to  another? 

The  poison,  or  contagium,  of  whooping-cough  is  generally 
supposed  to  be  very  volatile— i.  e.,  easily  spread  about  in  the 
air.  It  therefore  is  very  easily  contagious  if  a  sufferer  be 
brought  near  others  who  are  not  protected,  while  for  the  same 
reason  the  poison  is  thought  not  to  cling  to  apparel,  and 
hence  to  be  not  portable,  at  least  for  any  considerable  dis- 
tance. The  disease  is  communicable  from  a  person  as  long 
as  the  cough  continues. 


SEVERITY  OF  WHOOPING-COUGH  IN 
RELATION   TO   AGE 

Does  whooping-cough  generally  "go  harder"  with  infants,  say 
seven  or  eight  months  old,  than  with  children  somewhat  older, 
other  things  being  equal? 

We  cannot  answer  the  question  in  the  precise  form  in  which 
it  is  put— that  is,  to  say  whether  the  severity  of  the  disease 
is  greater  at  seven  or  eight  months  than  at  a  somewhat  later 


246  THE  CENTURY  BOOK  FOR  MOTHERS 

period,  because  we  do  not  know  how  much  older  children 
you  have  in  mind.  This,  however,  we  can  say:  The  mor- 
tality from  whooping-cough— doubtless  chiefly  from  pulmon- 
ary complications— is  much  greater  in  young  children  than 
in  those  of  what  is  called  "the  school  age."  In  fact,  the 
mortality  is  chiefly  under  three,  indeed  even  under  two  years 
of  age.  The  actual  per-centum  loss,  however,  in  children  of 
ordinary  strength  and  well  cared  for  is  not  very  great,  al- 
though among  the  poor  and  neglected  classes  the  disease  and 
its  sequels  account  for  an  enormous  total  mortality.  In  the 
mild  season  the  danger  of  pulmonary  complications  is  less, 
and  hence  the  danger  from  the  disease  is  less. 


DIFFICULTIES  OF  WALKING  AND 
DISORDERS  OF  THE  LIMBS 

THE   POSSIBLE   DANGERS   FROM  EARLY  WALKING 

Can  it  hurt  a  child  to  begin  to  walk  too  early?  My  little 
daughter  is  not  quite  eleven  months  old,  and  shows  a  very 
decided  desire  to  get  on  her  feet.  Should  she  be  discouraged? 
I  have  been  told  that  she  might  get  weak  ankles  or  some  other 
trouble  if  allowed  to  walk  too  soon. 

In  a  general  way,  it  may  be  said  that  if  a  child  were  urged 
to  walk  before  the  joint  tissues  were  strong  enough  certain 
deformities  might  ensue,  the  injuries  usually  attributed  to 
early  walking  being  bow-legs,  knock-knee,  and  weak  ankles. 
The  phrase  "weak  ankles"  generally  means  an  ankle  that  is 
not  firm  in  its  support  of  the  body  by  reason  of  relaxations  of 
the  ligaments,  particularly  those  on  the  sides  of  the  joint. 
Occasionally  we  see  a  'Sveak  ankle"  which  is  such  by  reason 
of  a  general  flabbiness  of  tissues,  the  muscles  of  the  leg  which 
move  the  foot  sharing  in  this  weakness.  There  is  a  kind  of 
knock-knee  also  due  to  relaxed  ligaments,  but  it  is  not  very 
common  in  children,  being  usually  acquired  later,  as  a  result 
of  injury,  or  of  some  peculiar  occupation.  Still,  it  is  well  to 
be  on  one's  guard  in  the  case  of  a  child  that  appears  to  be 
prematurely  desirous  of  getting  on  her  feet.  She  certainly 
ought  not  to  be  encouraged  in  any  way. 

247 


248  THE  CENTURY  BOOK  FOR  MOTHERS 


POSSIBLY   OVERBURDENED   LIMBS 

My  little  boy,  twenty  months  old,  seems  to  be  a  little  weak 
around  the  ankles,  and  when  he  is  walking  the  lower  part  of 
the  limb  appears  as  if  it  were  bowed.  He  is  very  healthy 
and  well  in  every  way,  and  weighs  something  over  thirty 
pounds.  The  legs  are  not  bowed,  but  can  be  pressed  together 
very  easily;  for  some  little  while  back  I  have  been  in  the 
habit  of  pressing  them  together  when  dressing  him  for  bed 
in  the  evening,  and  it  appears  to  have  done  some  good.  He 
has  not  been  sick  one  day  since  being  born.  Will  you  kindly 
give  me  some  advice  as  to  what  is  the  best  thing  to  do  under 
the  circumstances  ? 

It  is  not  clear  that  anything  is  really  the  matter.  The  child  is 
twenty  months  old,  and  his  weight,  if  it  be  nude  weight,  is 
that  of  a  three-year-old  child.  The  limbs  probably  are  a 
little  overburdened  at  present.  The  best  thing,  we  believe, 
will  be  to  gently  manipulate  them  to  stimulate  the  growth 
of  the  muscles,  and  to  try  to  discourage  unnecessary  standing. 


TURNING-IN   OF   THE   TOES 

What  can  be  done  for  a  twenty-months'  baby  who  shows  a  de- 
cided tendency  to  walking  with  toes  turned  in?  She  has  not 
inherited  the  tendency,  and  I  have  tried  to  be  careful  to  have 
her  shoes  large  enough,  though  she  grows  so  rapidly  that  her 
toe  generally  finds  the  end  before  the  new  ones  are  bought. 

Examine  carefully  (best  when  baby  is  naked)  to  see  if  the 
turning-in  is  at  the  ankle— or,  more  exactly,  at  the  joint  be- 
tween the  instep  and  ankle — or  whether  the  w^hole  limb  rolls 
in  from  the  hip.  If  the  trouble  is  in  the  foot,  perhaps  some 
support  is  necessary,  but  that  will  depend  upon  the  degree 
of  the  twist.  If  the  trouble  is  at  the  hip  it  may  be  only 
the  natural  tendency  to  walk  with  the  toes  forward  rather 
than  outward.  Rubbing  and  kneading  of  the  flesh  about  the 
hip  that  makes  the  prominences  of  the  buttocks  may  develop 


DISORDERS  OF  THE  LIMBS  249 

the  muscles  there  and  thus  give  greater  power  to  turn  out 
the  toes.  Such  cases  have  a  multitude  of  varieties  and  de- 
grees, and  the  need  of  artificial  support  cannot  be  definitely 
determined  from  a  short  description. 

In  walking  the  natural  tendency  to  turn  the  feet  in  is  par- 
ticularly marked  in  children.  It  is  often  observed  that  some 
children  turn  in  the  toes  of  one  or  both  feet  very  much  when 
walking,  although  no  real  club-foot  or  distinct  disease  exists. 
This  peculiarity  is  often— indeed,  usually— cured  before 
adult  life  by  the  child  itself  when  old  enough  to  give  its 
attention  to  it.  If  it  is  very  marked  it  probably  requires  the 
action  of  some  light,  properly  constructed  apparatus  to  over- 
come it.  This  can  be  directed  only  by  some  surgeon  familiar 
with  this  kind  of  cases,  and  he  can  best  advise  you  whether 
the  condition  is  really  of  sufficient  importance  to  need  treat- 
ment at  all.  By  yourself  you  can  do  little  more  than  to 
call  the  child's  attention  to  the  turning-in  of  the  toes  when 
she  is  old  enough  to  understand  you,  and  so  prompt  her  to 
an  effort  at  cure. 


DISINCLINATION   TO    PUT   THE    FOOT   DOWN 

Our  little  girl,  eight  months  old,  wants  to  stand  all  the  time  on 
her  toes,  and  it  is  hard  to  get  her  to  put  her  foot  flat  down. 
Can  we  do  anything  to  remedy  this,  or  will  she  outgrow  it? 

It  is  rather  early  for  the  child  to  be  making  serious  attempts 
at  walking,  and  until  she  does  the  question  cannot  really  be 
answered.  You  may  find  out  something  in  this  way:  When 
she  is  sitting  or  lying,  take  the  limbs  (one  at  a  time)  in  your 
hands ;  straighten  the  knee  completely,  so  that  the  thigh  and 
leg  are  in  a  straight  line;  hold  the  limb  thus,  and  press 
the  toes  and  front  of  the  foot  upward,  and  see  if  there  is 
any  difficulty  in  bringing  the  sole  to  a  right  angle  (or  rather 
beyond)  with  the  line  of  the  leg.  Do  this  several  times  to 
each  limb,  until  you  feel  quite  sure  what  is  the  condition. 
If  you  cannot  easily  bring  the  foot  to  or  beyond  the  right 


250  THE  CENTURY  BOOK  FOR  MOTHERS 

angle,  ask  your  physician  to  examine  it.  This  is  the  best 
advice  we  can  offer,  as  it  may  be  only  a  trick  of  the  child, 
or  it  may  be  due  to  some  unusual  rigidity  of  the  calf  mus- 
cles. There  are  a  number  of  ailments  in  which  this  draw- 
ing up  of  the  heel  exists. 


WEAK  LIMBS 

My  baby,  thirteen  months  old,  has  crept  for  some  time,  but  does 
not  try  to  stand  at  all  yet  or  pull  himself  up,  and  does  not 
seem  to  care  to  rest  on  his  feet.  As  he  is  quite  fleshy,  is  it 
best  to  let  him  partly  rest  his  weight  on  his  feet,  and  in  this 
way  teach  him  to  walk?  Some  of  my  friends  think  it  would 
be  best;  but  as  his  ankles  and  limbs  seem  weak  yet,  I  am  so 
afraid  of  injuring  them.     Will  you  please  give  your  opinion? 

Do  not  hurry  him  at  all.  If  he  does  not  walk  for  six  (or 
indeed  twelve)  months  yet,  it  is  better  than  putting  a  heavy 
baby  on  his  legs  prematurely.  A  baby  that  creeps  well  is 
not  without  ambition,  and  will  get  up  as  soon  as  it  is  safe. 
If  his  limbs  are  distinctly  weak  you  may  rub  them  and 
bathe  them  with  salt  and  water,  but  do  not  urge  him  to  walk 
at  present. 

THE  SIGNIFICANCE   OF   A   LIMP 

If  a  child  of  four  suddenly  begins  to  limp,  without  any  apparent 
cause,  and  continues  to  do  so  for  some  time,  is  it  a  sign  of 
hip  trouble? 

Not  necessarily.  Limps  come  from  many  causes  associated 
with  the  lower  limbs  or  the  spine,  especially  its  lower  part. 
The  persistent  limps  of  children  nearly  all  belong  to  two 
groups— those  which  are  due  to  loss  of  muscular  power,  such 
as  follows  any  kind  of  paralysis,  and  those  which  are  due  to 
the  endeavor,  often  unconscious,  to  spare  an  inflamed  or  sen- 
sitive joint.  To  the  latter  group  belongs  the  limp  of  hip 
disease  in  its  early  stages.     If  a  child  with  any  tender  joint 


DISORDERS  OF  THE  LIMBS  251 

or  bone  of  the  lower  extremity  be  watched  it  will  be  observed 
that  that  particular  joint  shares  less  than  it  should  in  the 
motions  of  the  limb  or  not  at  all.  If  it  be  the  hip  which 
is  at  fault,  that  joint  will  be  noticed  to  be  more  or  less  rigid 
in  walking  or  if  the  member  be  moved.  Ordinarily  the  lower 
part  of  the  spine  endeavors  to  move  more  than  is  usual  to 
make  good  the  loss  of  mobility  at  the  hip.  If  a  child  is  no- 
ticed for  any  reason  persistently  or  frequently  to  spare  a 
joint,  it  is  advisable  to  seek  medical  opinion. 

POTT'S   DISEASE 

What  are  the  first  symptoms   of  Pott's  disease?     What  is   its 
cause  and  cure? 

Ordinarily  the  first  thing  that  the  family  notices  is  the  promi- 
nence of  the  affected  vertebra.  But  there  can  usually  be 
noticed,  sometimes  earlier,  a  rigidity  of  the  spine,  an  unwill- 
ingness to  bend  it,  and  unconscious  endeavors  to  relieve  it 
from  bearing  weight,  as  by  lying  down  or,  in  standing,  to 
hold  on  to  chairs  or  furniture  or  to  support  the  shoulders 
and  chest  by  the  hands  upon  the  knees,  so  that  the  weight  is 
carried  upon  the  arms,  knees,  and  legs,  rather  than  upon 
the  spine.  Besides,  there  is  often  a  grunting  respiration  if 
the  chest  vertebra  are  affected,  colicky  pains  if  the  lower  ones 
are  the  seat  of  disease.  These  are  the  commonest  early  symp- 
toms likely  to  be  noticed  by  a  mother  or  an  attendant. 

The  disease  is  a  tubercular  inflammation  of  the  bone.  Its 
cause,  therefore,  is  essentially  the  infection  of  the  part  by 
the  tubercular  bacillus.  Some  have  thought  that  slight  in- 
juries have  proved  the  exciting  cause,  and  it  may  be  so,  but 
it  is  not  clear  whether  in  the  cases  in  which  an  injury  has 
occurred  the  latter  irritates  an  already  existing  tubercular 
deposit,  or  whether  the  disturbances  caused  by  a  slight  in- 
jury become  subsequently  infected.  The  main  factor  in  any 
case  is  the  tubercle. 

The  cure  is  a  very  long  and  tedious  one.     The  main  fea- 


252       THE  CENTURY  BOOK  FOR  MOTHERS 

tures  of  the  treatment  are  two:  The  employment  of  all  the 
hygienic  and  medicinal  remedies  which  are  effective  against 
tubercular  infection  anywhere,  and  the  support  of  the  spine 
by  proper  apparatus,  to  limit  irritation  and  prevent  de- 
formity as  far  as  possible. 

KNOCK-KNEE 

What  is  knock-knee  ?     How  can  one  clearly  recognize  that  a  baby 
who  is  just  beginning  to  walk  has  it? 

It  is  such  a  change  in  the  bones  or  the  joint  structures  as 
allows  the  knees  to  come  unduly  close  to  each  other,  or  even 
to  interfere  with  each  other,  while  usually  the  ankles  and 
feet  are  correspondingly  separated  more  than  usual. 

WEAK   ANKLES 

What  can  be  done  to  strengthen  weak  ankles  in  a  child  of  three 
years  ? 

The  weak  ankles  may  be  a  part  of  a  general  flabbiness  of 
make-up,  either  congenital  or  the  result  of  illness,  or  they  may 
be  due  to  a  lax  condition  of  the  ligaments  of  the  ankles.  In 
either  case,  but  especially  in  the  former,  everything  (includ- 
ing good  hygiene,  careful  feeding,  showering,  massage,  and 
rubbing  of  the  parts)  which  tends  to  strengthen  the  ankles  is 
proper.  Besides,  in  case  the  weakness  is  so  great  as  to  hinder 
the  proper  taking  of  exercise,  ankle  supports  of  leather,  ar- 
ranged to  go  inside  the  shoes  and  sold  in  the  shops,  may  be 
used.  This  is  about  the  limit  of  domestic  resource,  but  the 
physician  has  some  more  at  his  command. 


VI 

CONSTIPATION 


CONSTIPATION   IN   BOTH   MOTHER   AND   CHILD; 
LAXATIVE   DIET;    THE   ACTION   OF   SENNA 

I  have  always  been  more  or  less  constipated,  and  fear  that  my 
baby,  whom  I  am  nursing,  has  inherited  this  tendency.  Is 
this  generally  the  case  ?     She  is  otherwise  well  in  every  respect. 

Her  sister  of  two  and  a  half  is  also  troubled  by  constipation. 
What  would  be  a  laxative  diet  for  her? 

It  seems  to  be  generally  believed  that  constipation  in  a 
nursing  mother  is  the  cause  of  the  same  trouble  in  the  child, 
but  it  would  be  difficult  to  prove  or  disprove  this  assertion. 
It  certainly  happens  not  infrequently  that  both  mother  and 
child  are  constipated,  and,  if  the  child  is  nursing,  one  is 
tempted  to  consider  this  coincidence  as  cause  and  effect ;  but 
the  same  thing  happens  frequently  in  the  case  of  children 
who  have  never  been  nursed  by  their  mothers.  If  we  assume 
in  such  cases  a  hereditary  influence,  it  must  be  one  that  ante- 
dates the  birth.  The  fact  is  that  the  causes  of  chronic  con- 
stipation are  not  always  easily  recognized  nor  always  readily 
amenable  to  treatment.  As  we  have  said  once  before,  any 
physician  who  keeps  accurate  accounts  of  the  peculiarities  of 
the  families  he  treats  can  tell  of  individual  peculiarities 
which  seem  independent  of  ordinary  conditions.  For  in- 
stance, one  parent  is  habitually  constipated,  the  other  never 
has  a  hint  of  it.  One  child  is  ''as  regular  as  clockwork," 
while  the  other  scarcely  ever  has  an  evacuation  without  some 

253 


254  THE  CENTURY  BOOK  FOR  MOTHERS 

remedy  or  assistance.  Yet  the  hygiene  of  this  particular 
family  may  be  as  uniform  as  possible.  At  the  table  they 
all  eat  the  same  meals,  except  that  the  constipated  ones  may 
eat  less  of  the  constipating  food  than  the  others.  The  cause 
must  lie  in  some  difference  of  the  nervous  and  muscular  ac- 
tion of  the  bowels. 

If  milk  is  still  the  principal  part  of  the  child's  diet, 
it  will  be  advisable  to  add  a  tablespoonful,  or  even  more  if 
the  milk  is  rather  thin,  of  cream  to  each  glass  of  milk  the 
child  drinks.  The  porridges  of  oatmeal  so  commonly  used 
help,  by  their  bulky  refuse,  to  relieve  constipation,  and  their 
effect  is  increased  by  the  addition  of  cream  to  the  milk. 
Bread  made  of  whole  wheat  (Graham  or  other  unbolted  flour) 
is  preferable  to  white  bread.  As  regards  fruit,  peaches  are 
excellent.  A  little  later,  good  pears  and  apples  may  be 
given ;  they  should,  however,  always  be  scraped  with  a  spoon. 
In  winter,  one  may  give  the  juice  and  pulp  of  the  orange, 
which  is  about  the  only  useful  uncooked  fruit  obtainable,  but 
various  cooked  fruits  may  be  given.  Of  vegetables,  spinach, 
cauliflower,  asparagus,  and  celery  are  admissible.  They 
must  be  fresh,  thoroughly  cooked,  finely  cut,  and  the  spinach 
should  be  made  into  a  good  puree,  not  served  as  '  *  greens ' '  in 
country  style. 

MAGNESIA   AS    A    LAXATIVE 

Is  there  any  harm  that  can  possibly  be  done  by  giving  a  child 
magnesia?  I  was  advised  to  use  it  in  the  cream  food  in 
place  of  the  lime-water,  on  account  of  its  laxative  effect. 
Baby,  eight  months  old,  is  badly  troubled  with  constipation. 
I  put  about  half  a  teaspoonful  into  each  of  the  five  or  six 
feedings  per  day. 

Magnesia  is  probably  not  so  harmful  as  was  formerly  sup- 
posed. It  is  soluble  and  laxative  only  in  combination  with 
some  acid,  which  acid  may  be  met  in  the  alimentary  canal. 
The  older  physicians  always  gave  warning  of  the  danger  of 
masses  forming  in  the  bowels.     This  may  have  occurred,  but 


CONSTIPATION  255 

must  have  been  very  rare,  as  magnesia  has  been  given  very 
freely  as  a  domestic  remedy.  On  the  other  hand,  it  is  not  a 
desirable  remedy.  If  a  laxative  antacid  be  desired,  bicar- 
bonate of  soda  has  all  the  advantages  of  magnesia,  without 
its  alleged  disadvantages. 


CONSTIPATION   IN   A  "BOTTLE   BABY" 

Will  you  please  tell  me  what  I  can  do  to  relieve  my  baby  of  con- 
stipation? He  is  four  months  old  and  has  always  been  trou- 
bled with  it.  For  a  long  time  I  was  obliged  to  use  a  soap  sup- 
pository or  water  injection  very  frequently.  My  physician  at 
last  prescribed  something,  but  I  find  I  must  give  it  very  fre- 
quently to  keep  the  passages  normal. 

I  have  been  obliged  to  use  a  bottle  for  him  almost  from  the  first. 
I  have  used  cow's  milk  entirely  for  him.  Do  you  think  it 
may  be  harmful  to  continue  the  use  of  suppositories  and  in- 
jections ? 

To  answer  offhand  is  more  than  we  can  do.  Constipation 
is  an  extremely  common  ailment  in  infants,  particularly  if 
bottle-fed.  How  much  you  have  diluted  the  cow's  milk  and 
with  what  we  do  not  know.  Possibly  the  constipation  would 
yield  in  part  to  the  freer  use  of  sugar  and  cream  with  the 
milk.  So,  too,  usually  the  use  of  oatmeal  gruel,  not  too 
finely  strained,  for  dilution  of  the  milk  is  often  somewhat 
laxative. 

As  to  medication,  we  prefer  for  habitual  use  the  introduc- 
tion of  a  suppository  or  an  enema  to  the  administration  of  a 
laxative.  The  soap  pencil,  the  pencil  of  molasses  candy,  and, 
most  efficient  of  all,  the  glycerin  suppository  are  very  use- 
ful. Very  often  the  most  persistent  care  is  necessary  to  keep 
the  bowels  relieved  until  the  child  is  old  enough  to  eat  and 
digest  a  mixed  dietary.  We  have  followed  a  good  many 
children  who  were  troubled  with  constipation  in  infancy, 
and  found  them  entirely  and  satisfactorily  regular  by  two 
and  a  half  to  three  years  of  age. 


256  THE  CENTURY  BOOK  FOR  MOTHERS 

CASTILE  SOAP  SUPPOSITORIES;  CANDY   SUPPOSITORIES 

Don't  you  think  suppositories  of  Castile  soap  are  preferable  to 
those  of  bar-soap?  The  old-fashioned  molasses  suppositories 
work  more  kindly  with  my  children  than  anything  else  for 
constipation. 

The  Castile  soap  has  the  advantage  over  other  soaps  of  being 
usually  a  well-made  and  bland  soap  and  less  irritating,  and 
it  is  so  far  preferable.  There  are  children,  however,  whose 
bowels  seem  to  need  the  stimulus  of  the  coarser  variety.  The 
candy  suppository  has  ''the  wisdom  of  our  fathers"  in  its 
favor. 

OBJECTIONS  TO   SUPPOSITORIES;  THE   EFFECT  OF 
MASSAGE;   THE  VALUE  OF   REGULAR   HABITS 

In  my  experiences  with  two  very  constipated  children  I  found 
that  the  use  of  soap  and  a  roll  of  paper  induced  piles — quite 
as  great  an  evil  as  constipation. 

My  method,  which  entirely  cured  my  babies  of  constipation,  was 
to  rub  and  knead  the  bowels  with  oil  thoroughly  every  night 
and  morning,  and  to  put  them  on  the  stool  at  a  regular  time 
each  day.  With  this  treatment  I  adopted  a  laxative  diet  for 
myself,  and  when  they  were  weaned  gave  them  as  much  lax- 
ative food  as  possible. 

I  am  persuaded  that  the  use  of  soap,  stick-candy,  or  paper, 
which  produces  an  irritation  of  the  rectum,  is  not  always  wise. 

Your  experience  of  course  justifies  your  abandoning  the  sup- 
positories; but,  judging  from  considerable  personal  experi- 
ence and  the  reports  of  many  others,  the  soap  rarely  has 
such  an  effect.  There  are  some  persons  (adults)  so  sensi- 
tive as  to  complain  of  being  irritated  by  so  unirritating  a 
thing  as  a  well-oiled  syringe  nozzle,  but  this  is  rare.  One 
source  of  irritation  in  the  use  of  suppositories  is  the  press- 
ing too  firmly  in  introducing  them.  If  the  point  is  intro- 
duced into  the  seat,  and  a  very  little  time  is  allowed  to  elapse 
before  pressing  further,  the  first  spasm  of  the  muscle  re- 


CONSTIPATION  257 

laxes,  and  the  pencil  is  readily  introduced.  The  soap  is 
often  made  less  irritating  by  scraping  it  and  forming  a  sup- 
pository of  the  scrapings.  This  is  introduced  easily  and  is 
not  hard.  AVe  have  never  known  real  piles  (as  distinguished 
from  an  irritation  of  the  anus)  produced  by  the  use  of  any 
of  the  suppositories  recommended,  but  we  accept  your  diag- 
nosis. 

The  regulation  of  the  mother's  diet  is  important.  The 
friction  and  kneading  of  the  bowels  have  some  value,  but 
in  the  regularity  of  putting  the  child  upon  the  stool  you  have 
touched  the  most  important  point  of  all.  Of  course,  it  is 
inapplicable  to  very  young  infants,  but  in  adult  life,  as  well 
as  in  childhood,  the  rigid  following  of  this  rule  often  cures 
constipation  without  any  medicinal  treatment  at  all.  There 
is  excellent  physiological  reason  for  it,  which  we  cannot  go 
into  here. 

THE  EFFECT  OF  AN   ENEMA 

Will  you  kindly  tell  me  if  the  habit  of  giving  babies,  for  con- 
stipation, enemas  of  warm  water  twice  a  day  is  an  injurious 
one,  or  if  it  is  apt  to  lead  to  serious  inactivity  of  the  bowels? 

The  question  might  be  restated  thus:  Is  an  enema  twice  a 
day  more  or  less  harmful  than  allowing  the  bowels  to  remain 
unmoved  or  than  some  other  remedy?  It  hardly  need  be 
said  that  any  remedy,  w^hether  medicine,  suppository,  or 
enema,  is  objectionable  if  an  evacuation  can  be  obtained  by 
such  natural  stimulants  as  laxative  food  or  exercise;  but  if 
something  must  be  given,  then  what?  The  objection  to  the 
enema  is  the  possible  dilatation  of  the  lower  bowel,  and  a 
greater  tolerance  of  retained  matter.  The  choice  is  gener- 
ally between  an  enema  and  a  suppository.  Once  a  day  is  less 
objectionable  than  twice. 


17 


vn 

VARIOUS  DIGESTIVE   DISTURBANCES 

A  PROBABLE  CASE   OF  "DYSPEPSIA" 

Could  you  quiet  my  great  anxiety  by  telling  me  whether  a  child 
who  only  recently  began  speaking  through  her  nose  will 
of  herself  lose  that  trouble?  She  has  been  sick  with  de- 
rangement of  the  stomach,  and  is  always  very  constipated;  but 
since  three  weeks  ago  she  is  up  again,  though  her  tongue  con- 
tinues coated.  Ever  since  she  has  been  sick  she  speaks  dread- 
fully through  her  nose,  and  often  picks  at  it,  too.  When  I  make 
her  repeat  her  words  loudly  it  sounds  less  nasal,  but  we  should 
feel  greatly  troubled  were  she  always  to  speak  so.  She  has 
since  her  illness  grown  very  thin,  and  every  moment  attempts 
to  clear  her  throat  in  a  way  which  is  painful  to  listen  to.  The 
doctor  said  it  is  a  nervous  freak;  she  once  before  had  it,  last 
spring,  but  lost  it  later,  so  I  am  not  quite  so  much  worried 
about  it  as  I  then  was.  She  seems  weak,  and  toward  evening 
always  appears  tired  out.  She  is  four  and  a  half  years  old, 
and  has  for  almost  two  years  not  taken  afternoon  naps.  I 
have  of  late  tried  to  have  her  again  sleep  afternoons,  but  with- 
out avail;  she  only  lies  down  and  rests  that  way.  Mornings, 
when  she  first  wakes  up,  she  complains  of  pains  in  her  head, 
and  similarly  when  she  goes  to  bed.  Invariably  after  she  falls 
asleep,  and  is  asleep  half  an  hour  or  so,  she  cries  out  as  if 
scared;  but  we  can  soon  quiet  her.  Is  that  habit,  or  is  there 
some  distinct  cause  for  it? 

This  child  is  evidently  still  ill,  although  less  so  than  she  has 
been.     She  has  still,  as  enumerated,  a  catarrh  of  the  nasal 

258 


VARIOUS  DIGESTIVE  DISTURBANCES  259 

passages  and  throat,  foul  tongue,  debility— most  marked  to- 
ward evening— morning  headache,  and  broken  sleep.  A 
child  in  that  condition  needs  systematic  care  by  a  physician, 
and  should  not  be  treated  by  the  parent  alone.  By  this  we 
do  not  mean  that  the  physician  must  see  her  often,  but  he 
should  prescribe  for  her,  either  seeing  her  or  being  informed 
of  her  condition  at  fixed  intervals  (to  be  fixed  by  him)  until 
she  is  better.  If  we  were  to  guess  at  the  child 's  ailment,  we 
should  say  that  she  had  what  is  usually  called  "dyspepsia" 
—that  is,  a  disordered  condition  (catarrh)  of  the  stomach 
and  upper  intestine.  Proper  treatment  will  cure  it,  and 
make  her  sound  again.  The  nasal  symptoms  will  improve 
with  the  rest;  but  if  anything  remains  of  them,  local  treat- 
ment of  the  catarrh  will  be  very  helpful.  Sprays  of  listerine, 
or  some  other  disinfectant  which  your  physician  may  rec- 
ommend, will  probably  be  of  decided  benefit. 

HABITUALLY  COATED  TONGUE 

Can  you  suggest  a  remedy  for  an  habitually  coated  tongue? 
My  little  boy  is  three  years  of  age,  has  a  fair  appetite,  and 
lives  mostly  upon  milk,  with  the  addition  of  some  fruit  and 
vegetables,  a  little  meat,  and  simple  puddings.  I  have  con- 
sulted a  physician  concerning  his  diet,  who  advised  not  giving 
any  meat  while  the  tongue  remained  coated,  also  no  sweets. 
I  tried  this,  but  it  did  not  seem  to  make  any  great  difference. 
He  is  an  unusually  active  child,  sleeps  well  at  night,  and  also 
takes  a  nap  through  the  day.  He  weighs  thirty-six  pounds  and 
measures  thirty-seven  inches  in  height. 

Your  physician's  advice  was  in  accordance  with  the  ordinary 
understanding  of  such  cases,  and  is  probably  correct.  There 
are  instances  of  tongues  habitually  slightly  coated  or  whitish 
which  do  not  appear  to  have  any  concomitant  disturbances 
of  moment ;  but  these  are  exceptional.  Ordinarily  the  coated 
tongue  is  supposed  to  be  associated  with  a  deranged  state  of 
the  digestive  organs,  especially  the  stomach.  And  the  re- 
strictions of  diet  suggested  by  your  physician  are  usually 


260       THE  CENTURY  BOOK  FOR  MOTHERS 

demanded  to  insure  a  cure,  even  if  other  measures  need  to 
be  taken. 

EXCESSIVE  PERSPIRATION  OF  THE  HEAD  AND 
OTHER   SIGNS  OF   RICKETS 

My  baby  boy  perspires  a  great  deal.  Often,  especially  after  the 
noonday  sleep,  his  pillow  is  quite  wet.  I  think  that  this  ex- 
cessive perspiration  causes  his  hair  to  come  out,  as  he  does 
not  seem  to  have  as  much  now — at  the  age  of  six  months — 
as  he  had  some  time  ago.  His  head  is  quite  large.  He  is 
pretty  strong  and  heavy  for  his  age,  and  there  seems  to  be  no 
trouble  with  his  digestion,  although  his  stomach  is  large  and 
generally  quite  hard. 

There  is  a  popular  belief  that  excessive  perspiration  of  the 
head  causes  loss  of  hair,  but  we  doubt  whether  the  two  are 
really  cause  and  effect;  their  relation,  we  suspect,  is  that 
they  are  both  effects  of  a  common  cause.  Several  disorders 
of  nutrition  may  cause  a  large  abdomen  or  a  large  head,  but 
when  both  are  present,  with  the  peculiar  symptom  of  sweat- 
ing of  the  head,  it  is  extremely  probable  that  the  trouble  is 
rickets— a  condition  in  which  the  system  does  not  appro- 
priate sufficient  phosphate  of  lime.  It  is  an  ailment  that 
is  quite  common,  but  also  very  commonly  overlooked,  unless 
it  goes  very  far.  It  is,  fortunately,  quite  easily  controlled 
by  proper  diet  and  treatment,  but  is  not  within  the  scope  of 
domestic  medicine.  A  competent  physician  ought,  by  all 
means,  to  prescribe  a  suitable  diet  for  your  child. 

THE   USES  OF   BICARBONATE  AND   PHOSPHATE 
OF  SODA   FOR  WEAK   DIGESTION 

Will  you  kindly  enlighten  me  on  the  following  points?  My 
baby  boy,  fourteen  months  old,  has  always  been  small  and 
delicate.  He  was  weaned  two  months  ago,  and  on  account  of 
his  extremely  weak  digestion  I  was  obliged  to  add  an  alkali 
to  his  milk,  which  I  dilute  with  one  third  strained  oatmeal. 
On  account  of  his  habitual  constipation  I  use  carbonate  of 


VARIOUS  DIGESTIVE  DISTURBANCES  261 

soda  instead  of  lime-water.  I  received  the  suggestion  from  a 
good  authority,  but  I  am  aware  that  both  lime-water  and  soda 
were  recommended  "temporarily  to  counteract  acidity."  Now 
I  am  becoming  anxious  about  continuing  to  add  the  soda, 
though  I  still  fear  to  omit  it. 

Please  inform  me  whether  its  continued  use  may  be  injurious 
to  my  little  one,  and  enlighten  me  as  to  what  bad  eflFects  it 
would  produce. 

Is  phosphate  of  soda  an  alkali? 

The  persistent  use  of  any  drug  should  be  avoided,  unless 
there  is  evident  reason  for  its  administration.  As  to  the 
bicarbonate,  we  should  say  that  it  is,  perhaps,  as  little  harm- 
ful as  any.  But  its  use  is  chiefly  as  an  antacid,  rather  than 
a  laxative.  It  is  put  into  milk  only  to  make  sure  that  the 
latter  is  not  sour,  and  to  prevent  too  sudden  curdling.  It  is 
safer  to  have  blue  litmus-paper  in  the  house,  with  which  to 
test  the  acidity  of  the  milk,  and  to  add  the  soda  or  not,  as  re- 
quired. Blue  litmus-paper  is  reddened  by  any  liquid  having 
an  acid  reaction.  The  druggist  who  sells  you  the  paper  will 
explain  its  use  to  you.  The  sudden  curdling  is  perhaps  bet- 
ter prevented  by  the  addition  to  the  milk  of  barley  or 
oatmeal- water,  which  act,  as  is  supposed,  by  mechanical  hin- 
drance to  the  formation  of  large  curds.  Soda  has  a  medici- 
nal value  also  if  the  stomach  secretion  is  believed  to  be  too 
acid  (it  is  acid  naturally),  Avhich  is  evidenced  by  hard  or 
large  curds  or  uncommon  acidity  in  the  vomited  matters,  or 
similar  curds  in  the  passages.  All  alkalies,  if  abused,  are 
supposed  to  have  the  effect  popularly  called  ''thinning  the 
blood, ' '  but  the  soda  salts  are  generally  better  tolerated  than 
those  of  potash. 

Phosphate  of  soda  has  a  slightly  alkaline  reaction,  but  it  is 
not  counted  as  an  alkali.  It  is  a  useful  laxative  or  purgative, 
according  to  dose. 

"LIVER  TROUBLES'' 

I  wish  to  solicit  your  opinion  regarding  inherited  liver  troubles. 
Can  they  be  outgrown?    And  will  any  particular  diet  aid  the 


262  THE  CENTURY  BOOK  FOR  MOTHERS 

cause?     Milk  in  any  form  known  to  me  will  induce  an  attack 
in  both  my  babies. 

We  answer  your  question  rather  doubtfully,  because  we  are 
not  sure  that  we  know  what  is  meant  by  'inherited  liver 
troubles."  "Liver  troubles,"  "liver  complaint,"  and  the 
like  are  popular  phrases,  probably  inherited  from  the  medi- 
cal speech  of  previous  generations,  which  now  have  no  defi- 
nite meaning.  We  think  that  they  are  generally  used  to 
express  a  catarrh  of  the  stomach  or  upper  intestine.  But 
from  what  you  add  we  suspect  that  you  mean  an  inability 
to  digest  milk  without  difficulty. 

The  development  of  the  digestive  powers  is  such  as  gives 
ground  for  hoping  that,  as  this  power  strengthens,  the  ability 
to  digest  milk  will  be  increased.  But  we  may  add  that  a  real 
inability  to  digest  milk  if  properly  taken  is  very  rare  indeed. 
There  is  a  very  general  disability  to  digest  milk  if  it  is  con- 
sidered as  a  drink,  and  not  as  a  food.  We  mean  that  people 
take  or  allow  their  children  to  take  milk  with  other  food  as 
they  would  water,  disregarding  the  fact  that  it  is  itself  a 
very  highly  nutritious  food.  We  often  see  children  at  table 
who,  having  already  eaten  enough,  pour  into  their  stomachs 
a  glass  or  two  of  milk,  alone  enough  for  a  good  meal,  and 
often  cold  enough  to  arrest  all  digestion.  The  result  is  very 
usually  such  a  catarrhal  attack  as  is  called  "bilious."  One 
of  the  ways  in  which  the  inability  to  digest  milk  is  "out- 
grown" is  by  learning  this  simple  rule:  Take  it  for  food, 
not  for  drink ;  take  it  slightly  warm  as  you  would  any  other 
food,  and  do  not  make  young  children  (i.  e.,  under  a  year 
and  a  half)  try  to  eat  undiluted  cow's  milk. 

DOMESTIC  TREATMENT  OF  SUMMER   COMPLAINT 

Can  you  publish  some  remedy  for  the  domestic  treatment  of 
summer  complaint?  I  am  going  North  with  my  youngest 
child,  a  baby  of  eleven  months,  who  is  inclined  to  bowel  trou- 
bles, and  am  anxious  to  be  provided  with  the  proper  reme- 
dies for  an  emergency. 


VARIOUS  DIGESTIVE  DISTURBANCES  263 

Against  an  emergency  it  is  well  to  have  in  the  house  some 
chalk  mixture,  or,  better  yet,  the  compound  chalk  powder, 
as  the  mixture  is  apt  to  spoil  in  hot  weather;  also  a  very 
small  vial  of  the  compound  tincture  of  catechu  and  another 
of  paregoric.  A  mixture  can  then  be  made  as  needed,  thus : 
Take  a  level  teaspoonful  of  the  chalk  powder  and  mix  with 
six  of  water ;  rub  or  stir  thoroughly  together,  until  no  lumps 
exist,  then  add  a  teaspoonful  of  the  catechu  tincture  and  mix 
thoroughly.  The  dose  of  this  mixture  for  a  child  of  one 
year  will  be  a  teaspoonful,  and  to  each  dose  five  drops  of 
paregoric  may  be  added.  The  paregoric  is  not  mixed  with 
the  other  ingredients,  as  it  is  frequently  desirable  to  stop  the 
paregoric  while  the  medicine  is  continued.  Little  children 
sometimes  show  marked  susceptibility  to  opium  poisoning; 
hence  the  effect  of  each  dose  is  to  be  noted,  and  if  drowsi- 
ness appears  the  paregoric  should  be  omitted ;  otherwise,  the 
dose  can  be  given  every  two  hours  if  the  purging  continues. 
It  ought  to  be  stated  that  these  drugs  are  not  to  take  the 
place  of  other  measures  which  the  physician  will  indicate. 
The  suggestions  are  intended  only  for  use  in  case  a  physi- 
cian is  not  readily  at  hand. 


APPARENT  OVERFEEDING 

My  little  girl,  four  weeks  old,  seems  to  be  troubled  with  indiges- 
tion. She  spits  up  so  much  after  nursing  that  it  seems 
scarcely  possible  that  her  stomach  has  retained  any  of  the  milk. 
Then  almost  immediately  she  is  hungry  again.  I  nurse  her 
quite  regularly  every  two  and  a  half  hours,  and  seem  to  have 
plenty  for  her.  Sometimes  the  milk  is  curdled  when  she  raises 
it,  but  more  frequently  not. 

She  is  troubled  and  restless  after  nursing,  and  often  cries  out 
when  spitting  up.  She  weighed  seven  and  three  quarter 
pounds  when  born,  and  now  weighs  ten  and  one  half 
pounds.  Her  bowels  move  three  or  four  times  in  twenty-four 
hours;  the  color  is  good,  but  there  are  curds  in  the  move- 
ments, and  she  almost  always  cries  before  the  bowels  are 
moved.     Those  I  have  consulted  say,  "spitting  up  makes  a  fat 


264       THE  CENTURY  BOOK  FOR  MOTHERS 

baby,"  and  "it  is  healthy,"  but  it  does  not  seem  to  me  to  be 
right.     Can  you  advise  what  is  best  to  do? 

The  symptoms  are  very  suggestive  of  over-distention  of  the 
stomach.  A  child  at  four  weeks  can  rarely  take  comfort- 
ably more  than  two  fluid  ounces  (four  tablespoonfuls) ,  and 
if  your  flow  of  milk  is  large,  and  particularly  if  it  contain 
a  good  deal  of  solid  matter— butter,  casein,  etc.— the  regur- 
gitation would  very  likely  follow.  If  the  trouble  still  con- 
tinues, see  that  she  gets  smaller  meals.  The  repeated  de- 
mands for  food  are  the  results  of  the  indigestion,  not  of 
normal  huno;er. 


INDIGESTION;    DILUTION  OF  MILK  CALLED   FOR 

My  baby  boy  is  just  six  months  old,  has  one  tooth,  and  another 
visible.  I  nursed  him  partly  until  five  months;  since  then  he 
gets  pure  cow's  milk,  sterilized,  lime-water  in  every  bottle, 
each  bottle  holding  six  ounces.  His  meals  he  gets  regularly, 
three  hours  apart.  He  has  always,  with  the  exception  of  the 
last  few  weeks,  been  well,  his  digestion  having  been  perfect 
until  lately,  but  now  he  has  stool  sometimes  five  and  six  times 
in  twenty-four  hours,  and  he  has  no  appetite  whatever;  his 
sleep  also  has  been  restless  since  teething  began. 

Ought  I  to  put  cream  in  his  milk;  what  can  I  do  for  his  appe- 
tite; must  I  change  his  food,  and  if  so,  what  shall  it  be? 

A  child  of  six  months  usually  cannot  safely  take  pure  {i.  e., 
undiluted)  cow's  milk.  The  average  baby  of  twelve  months 
finds  it  more  than  he  can  digest.  You  ought  certainly  not  to 
add  cream,  unless  to  a  much  diluted  milk.  We  favor  '  *  cream 
foods,"  but  they  are  not  made  by  adding  cream  to  milk 
alone.  One  of  the  best  has  this  composition:  Milk,  four 
tablespoonfuls ;  cream,  six  tablespoonfuls ;  water,  twenty 
tablespoonfuls;  milk-sugar,  a  tablespoonful  slightly  heaped. 
After  sterilizing,  add  two  tablespoonfuls  of  lime-water. 
This,  as  you  see,  makes  a  pint  of  food.  But  you  can  prob- 
ably do  better  than  that  now  by  simply  diluting  the  milk 


VARIOUS  DIGESTIVE  DISTURBANCES  265 

with  an  equal  bulk  of  boiled  water,  the  lime-water  to  be  in- 
cluded in  this  amount  of  water.  Probably  his  appetite  will 
improve  when  his  dietary  is  more  suitable. 


PAREGORIC   FOR   GREEN   MOVEMENTS 

Is  the  use  of  paregoric  harmful  if  given  for  green  movements,  in 
doses  of  five  drops  in  half  a  teaspoonful  of  water  every  two 
or  three  hours  ?     How  much  may  be  given  in  that  way  ? 

It  may  not  be  harmful,  but  it  does  not  attack  the  cause  of 
the  green  stools,  it  only  diminishes  their  frequency.  The 
green  stools  usually  are  over-acid,  and  the  green  color  is  be- 
lieved to  be  due  to  a  microbe  which  flourishes  in  them.  The 
purification— or  disinfection— of  the  intestinal  canal  is  essen- 
tial to  success.  The  drugs  best  suited  to  this  you  would  not 
be  able  to  select  wisely,  and  you  should  rely  upon  your 
physician  for  them. 

THE  CAUSES  OF   DIRT-EATING 

My  baby  boy,  who  is  ]iow  twenty-six  months  old,  has  for  months 
had  the  habit  of  eating  dirt,  when  playing  out  of  doors.  Is 
there  something  lacking  in  his  food?  I  have  always  been 
very  careful  about  what  he  eats.  Until  he  was  fifteen  months 
old  I  gave  him  only  sterilized  milk.  Since  then  he  has  had 
bread  and  milk,  bread  and  butter,  rice,  and  soft-boiled  egg. 
Last  summer  I  gave  him  a  little  fruit.  Can  you  tell  me  why 
he  persists  in  the  habit  I  have  mentioned? 

The  morbid  appetite  is  not  rare,  but  usually  is  found  in 
connection  Avith  disordered  digestion  or  a  disordered  ner- 
vous system,  and,  in  adults  at  least,  in  connection  with  the 
hysterical  peculiarity.  Examine  in  these  directions  for  a 
cause. 


VIII 
ERUPTIONS 


THE   CHARACTERISTICS   OF   MILD   AND 
OF   SERIOUS   ERUPTIONS 

Is  there  any  way  of  telling  the  difference  between  a  little  harm- 
less rash — heat-rash,  so  called,  for  example — and  that  of  scar- 
let fever,  measles,  etc.?  If  it  was  the  beginning  of  a  severe 
case,  of  course  the  other  symptoms  would  make  themselves 
known ;  but  how  would  it  be  in  a  light  case,  and  with  an  infant, 
who  could  not  tell  its  feeling? 

I  have  a  little  nephew,  about  three  months  old,  who,  when  his 
mother  was  just  about  to  bathe  him  one  morning,  exhibited  a 
slight  rash.  She  was  rather  in  a  dilemma,  not  knowing 
whether  it  amounted  to  anything  or  not,  and  whether  she 
should  give  the  baby  his  usual  bath  and  send  him  out  for  his 
airing  in  the  carriage,  or  call  in  her  physician.  She  finally 
decided  that  it  did  not  amount  to  anything,  and  her  judgment 
in  this  case  proved  correct;  but  what  if  she  had  been  wrong 
and  the  result  serious? 

The  differences  are  not  easy  to  describe  in  words,  and  it  is 
said  that  in  hot  weather  even  physicians  have  mistaken  Ger- 
man measles  and  some  other  eruptive  disorders  for  prickly 
heat.  The  most  striking  distinction  to  the  untrained  eye 
between  scarlatina  and  prickly  heat  we  think  is  the  eleva- 
tion of  the  eruption  of  prickly  heat  above  the  skin.  It  is 
composed  of  minute  conical  elevations  with  or  without  a 
watery  liquid  in  a  vesicle  at  the  top,  and  the  inequality  can 
be  recognized  by  passing  the  fingers  over  the  surface.     The 


ERUPTIONS  267 

eruption  of  scarlatina  is  made  of  minute  bright  red  points, 
afterward  coalescing,  appearing  first  on  the  neck,  and  then 
on  the  chest,  and  spreading,  and  brightest  where  covered. 
Measles  has  a  duller  red  eruption,  which  appears  in  cres- 
centic  patches  around  the  ears  and  on  the  face  first,  and  is 
brightest  where  exposed.  German  measles  looks  more  like 
measles  at  first,  and  then  more  like  scarlatina.  Prickly  heat 
is  most  abundant  on  or  confined  to  parts  where  the  clothing 
retains  the  perspiration.  It  comes  almost  exclusively  in  hot 
weather.  The  eruptive  fevers  are  more  prevalent  in  the 
cooler  season— i.  e.,  the  season  of  closed  and  unventilated 
houses. 

"DRIVING   IN"   ECZEMA 

Is  it  really  dangerous  to  try  and  heal  eczema  on  a  child's  face? 
My  baby  was  afflicted  with  it  until  eight  months  old,  and  I 
was  warned  not  to  attempt  to  heal  it,  as  that  would  "drive  it 
in"  and  produce  some  form  of  sickness  as  a  result.  Our  physi- 
cian prescribed  zinc  ointment  (which  did  no  good),  and  said 
the  ailment  would  probably  last  until  baby  had  all  her  teeth; 
then  it  would  pass  away.  At  grandmother's  suggestion,  how- 
ever, I  tried  a  mild  solution  of  salt  and  water  when  washing 
baby's  face,  following  that  each  time  with  talcum  powder,  and 
this  did  more  good  than  anything  else.  Then  we  went  to  the 
seashore,  where  baby  had  the  salt  air  and  sea-water  for  a  final 
plunge  after  each  bath  (the  chill  taken  off  by  the  addition  of 
plain  hot  water),  and  within  a  couple  of  weeks  the  eczema  had 
disappeared.  We  remained  by  the  sea  until  baby  was  ten 
months  old,  and  the  eczema  has  never  returned  in  the  same 
degree,  but  only  in  occasional  patches  during  the  cutting  of  a 
tooth  or  some  little  disorder  of  the  stomach,  such  as  babies 
have.  If  there  is  danger  in  curing  the  eczema  ordinarily,  why 
did  no  ill  results  follow  the  natural  cure  performed  by  the  sea  ? 

There  is  no  danger  whatever  in  treating  an  eczema ;  it  cannot 
be  ^'driven  in."  The  blunder— a  very  wide-spread  one  popu- 
larly—came about  thus:  Eczema  sometimes  depends  upon 
constitutional  conditions  that  vary  their  points  of  manifesta- 


268       THE  CENTURY  BOOK  FOR  MOTHERS 

tion;  when  a  new  point  is  attacked  the  eczema  sometimes 
disappears.  So,  too,  it  is  a  very  common  observation  that  two 
diseases  rarely  will  go  on  actively  at  the  same  time;  hence 
it  has  been  observed  that  an  eczema  has  disappeared  when 
an  internal  disease  in  no  way  connected  with  it  has  been  set 
up.  In  such  cases  the  eczema  might  be  said  to  be  ''called 
in,"  rather  than  "driven  in." 

Eczema  and  other  skin  diseases  should  be  always  healed 
as  soon  as  practicable.  The  notions  about  "driving  in" 
eruptions  are  ordinarily  simple  superstitions,  and  at  best 
are  founded  on  the  misapprehension  of  cause  and  effect. 
AVhen  a  severe  illness  occurs  eruptions  sometimes  fade,  and 
the  careless  observer  thinks  that  the  illness  was  caused  by 
the  disappearance  of  the  skin  disease,  when  the  reverse  was 
the  truth.  We  may,  however,  say  that  such  eruptions  are 
often  very  obstinate  and  hard  to  cure. 


HEAT-RASH 

My  little  girl,  twenty  months  old,  is  much  troubled  with  heat- 
rash.  We  bathe  her  with  bicarbonate  of  soda  and  water,  and 
use  zinc  or  lycopodium  powder,  but  neither  seems  to  do  her 
any  good.  Can  you  recommend  any  different  treatment? 
Would  it  be  well  to  use  vaseline?  She  has  lately  been  having 
a  good  deal  of  bowel  and  stomach  trouble,  but  that  is  ac- 
counted for  by  the  fact  that  she  is  just  getting  her  stomach 
and  eye  teeth.  We  feed  her,  by  our  doctor's  advice,  on  oat- 
meal gruel  and  milk  entirely.  Is  barley  equally  nutritious, 
and  would  it  be  less  heating  to  her  blood  ?  Would  it  be  well  for 
her  to  wear  linen  or  lawn  next  her  skin  under  her  thin  merino 
shirt?  The  rash  usually  comes  out  on  her  face  and  neck  with 
every  warm  spell,  but  this  time  it  is  all  over  her  body,  and  I 
don't  know  what  to  do  for  it. 

Derangement  of  the  digestive  tract  often  increases  the  sus- 
ceptibility of  the  skin,  and  anything  that  relieves  the  former 
will  in  so  far  help  the  other.  Just  what  things  your  child 
needs  in  this  way  your  physician  can  best  say.     The  heat- 


ERUPTIONS  269 

rash  is  usiially  kept  up  by  the  excessive  perspiration,  and 
the  lessening  of  the  latter  is  also  helpful.  Limiting  as  far 
as  possible  the  child's  activity  of  course  will  diminish  per- 
spiration ;  sometimes  the  use  of  alkaline  drinks  is  useful,  but 
they  should  not  be  employed  without  the  consent  of  the 
physician  who  is  familiar  with  her  stomach  trouble.  Again, 
light  and  loose  clothing— which  may  at  the  same  time  be 
sufficiently  warm  to  prevent  chilling— is  very  useful,  the 
worst  irritation  from  heat-rash  usually  being  at  points  where 
the  clothing  binds.  The  lawn  or  linen  shirt  under  the 
merino  is  often  useful  in  allaying  friction.  Barley  is  of  about 
the  same  nutritive  value  as  oatmeal,  but  less  laxative.  Some 
persons  find  oatmeal  ''heating,"  in  the  sense  of  favoring 
eruptions,  but  this  is  not  the  rule. 

RED-GUM 

My  baby  girl  is  six  months  old  to-day.  She  is  plump  and  usu- 
ally good.  At  the  age  of  two  months  she  had  red-gum,  and  it 
was  some  weeks  before  she  recovered.  It  (the  rash)  remained 
the  longest  and  brightest  wherever  the  wet  napkin  touched, 
and  even  yet  comes  and  goes  there.  An  orange  stain  is  often 
present.  The  opening  into  the  bladder  is  also  a  bright  red. 
She  has  been  of  a  very  constipated  habit,  but  by  giving  her  a 
little  "brown-bread  coffee"  I  now  secure  a  daily  movement.  I 
have  been  able  for  over  a  month  now  to  see  four  teeth,  the 
upper  front  ones,  but  they  are  not  yet  through. 

My  hope  is  that  you  can  give  me  definite  directions  as  regards 
her  urine,  and  also  tell  me  when  and  how  I  had  best  wean  her. 
I  have  plenty  of  milk,  when  I  can  get  milk  myself  to  drink  (just 
now  the  people  with  whom  I  am  boarding  have  but  little),  and 
have  nursed  her  regularly  until  six  weeks  ago,  every  two  hours 
in  the  day — once  at  night — and  since  then  every  three  hours. 

The  "red-gum"  and  the  present  rash  are  not,  strictly  speak- 
ing, the  same,  but  that  is  a  point  of  small  moment.  The 
eruption  under  the  napkin  is  very  common,  especially  if  the 
urine  be  very  acid,  as  it  probably  is  when  the  orange  deposit 


270  THE  CENTURY  BOOK  FOR  MOTHERS 

is  present.  To  correct  this  tendency  (which  is  probably  due 
to  peculiarities  of  digestion)  in  a  child  on  the  breast  is  not 
easy.  Something  may  be  done  by  giving  her  water,  and  we 
think  the  condition  will  probably  improve,  since  you  have 
adopted  the  three-hour  rule  in  place  of  the  two-hour  interval, 
which  was  continued  too  long.  Locally,  washing  the  parts 
with  weak  alkaline  washes— e.  g.,  lime-water,  or  very  weak 
soda  solution— will  allay  irritation.  If  the  skin  is  irritated, 
great  care  should  be  exercised  in  cleansing  the  parts  fre- 
quently, carefully  drying  them  and  powdering  or  dusting 
them  with  fuller's  earth  or  similar  preparations. 

PSORIASIS 

Will  you  give  me  some  information  regarding  psoriasis  in  young 
children  ?  My  little  girl,  six  years  old,  who  is  perfectly  healthy 
in  every  other  respect,  has  been  disfigured  with  this  disease  for 
more  than  three  years. 

Can  the  disease  be  entirely  eradicated,  and,  if  so,  how  long  is 
it  likely  to  take? 

Is  there  any  particular  period  of  life  when  it  can  be  most  favor- 
ably treated? 

What  effect  have  eruptive  fevers,  such  as  chicken-pox  and  mea- 
sles, on  the  disease? 

As  relapses  of  psoriasis  are  very  common,  and  as  the  erup- 
tion varies  at  different  times  in  the  course  of  a  year,  dis- 
appearing and  reappearing,  it  is  not  easy  to  say  how  often  a 
permanent  cure  is  effected.  The  particular  attack  may  be 
cured,  but  the  tendency  to  return  may  still  be  present.  For 
this  reason  no  specific  answer  can  be  given  to  the  ques- 
tion as  to  duration  of  treatment.  But  this  much  can  be 
safely  said,  that  some  cases  remain  cured  for  as  long  a 
time  as  the  physician  is  able  to  follow  them,  and  that  the 
treatment  may  require  only  a  few  weeks,  or  may  be  very 
tedious. 

It  should  be  treated  as  promptly  as  possible,  and,  as  age 
does  not  seem  to  materially  influence  its  appearance,  it  can- 


ERUPTIONS  271 

not  be  said  to  influence  the  time  at  which  treatment  will  be 
particularly  efficient. 

Probably  no  permanent  effect.     One  eruption  will  compli- 
cate the  other  temporarily. 


SEBORRHOEA 

Can  you  tell  me  the  cause  of  or  the  cure  for  the  scurf  which 
sometimes  forms  on  babies'  heads?  It  is  not  exactly  like  dan- 
druff, being  soft  and  yellow,  but  forms  in  small  scales  about 
the  size  of  dandruff.  With  my  three  children  it  begins  to 
appear  when  the  new  hair  begins  to  come  off.  It  scrapes  off 
easily  when  rubbed  with  vaseline,  but  forms  again  in  a  week 
or  two.  My  nurses  have  told  me  never  to  comb  or  scrape  it 
off,  but  no  one  seems  to  be  able  to  tell  me  of  any  other  way 
of  getting  it  off  or  any  way  of  preventing  its  coming.  After 
the  hair  gets  long  and  thick  it  seems  to  become  dry,  more  like 
dandruff,  though  still  yellow  in  color. 

The  trouble  is  doubtless  what  is  known  as  seborrhoea.  It 
has  a  greasy  form  and  a  dry  form,  the  latter  being  called 
dandruff.  Your  child  appears  to  have  the  greasy  form,  as 
is  usual  in  infancy.  There  are  some  superstitions  still  sur- 
viving against  the  removal  of  this  so-called  ''cradle  cap," 
but  they  are  only  superstitions.  The  cause  of  the  disease 
is  an  over-activity  of  the  glands  which  normally  secrete  the 
sebaceous,  or  unctuous,  matter  of  the  skin.  The  cure  of  it 
lies  in  keeping  the  skin  clean  by  shampooing  with  soap  or 
slightly  alkaline  solutions,  and  afterward  applying  stimulat- 
ing lotions.  Various  practitioners  have  their  favorite  for- 
mulas. 

RINGWORM 

My  little  boy,  four  years  old,  has  a  "ring-worm"  on  his  forehead 
about  one  inch  and  a  half  in  diameter.  I  have  used  a  prepa- 
ration of  potash,  and  it  seemed  to  stop  it  for  a  while.  I  am 
now  painting  it  with  iodine,  but  it  does  not  seem  to  do  much 
good.     Can  you  tell  me  what  causes  it,  and  how  I  can  cure  it? 


272       THE  CENTURY  BOOK  FOR  MOTHERS 

It  cannot  be  hereditary,  for  I  am  perfectly  healthy,  and  have 
never  had  anything  like  that,  nor  has  his  father. 

Ringworm  is  not  hereditary.  It  is  due  to  a  vegetable  para- 
site which  grows  upon  the  skin.  The  cure  consists  in  allay- 
ing the  inflammation  and  killing  the  parasite  to  the  last  spore. 
The  tincture  of  iodine  is  usually  successful  if  persisted  in. 
It  must  be  painted  over  all  the  changed  parts  of  the  skin. 
Daily  frictions  with  green  soap— a  kind  of  soap  much  used 
for  skin  diseases— are  useful,  and  any  germicide  not  too 
strong  will  help.  One  of  the  safest  for  domestic  use  is  the 
hyposulphite  of  sodium.  Dissolved  in  five  parts  of  water,  it 
may  be  applied  locally.  On  the  face  care  should  be  taken 
not  to  use  too  strong  applications,  as  slight  scars  may  be 
caused. 

HERPES   AND    ITS   CURE 

Can  you  tell  me  something  about  the  skin  disease  herpes,  also 
the  most  effectual  remedy,  and  if  it  is  likely  to  return  when 
occurring  in  a  child  of  nearly  two  years  who  has  still  to  get 
her  eye  and  stomach  teeth,  and  if  there  is  any  preventive 
measure  to  be  taken? 

The  name  herpes  is  an  old  one,  and  was  applied  to  a  number 
of  quite  diverse  ailments.  The  ailments  to  which  it  is  now 
restricted  by  most  writers  are  of  small  importance.  One  of 
these  is  the  eruption  called  ''cold  sores,"  occurring  about 
the  lips.  Cleanliness  and  a  soothing  salve  like  cold-cream 
generally  end  the  matter.  Possibly  you  may  mean  some 
other  disease  of  the  skin;  zoster,  or  shingles,  for  instance, 
was  once  classed  as  herpes. 


"BLACK-HEADS" 

I  wish  to  ask  your  opinion  regarding  a  certain  condition  of  the 
skin,  in  the  case  of  my  little  daughter,  which  is  unpleasant 
to  behold.  I  refer  to  the  choking-up  of  the  little  glands  on 
the  forehead  and  around  the  mouth,  which  become  blackened 


ERUPTIONS  273 

and  are  known  as  "black-heads."  Then  the  pores  of  the  skin 
of  the  nose  are  enlarged,  and  minute  fatty  particles  can  be 
pressed  out.  This  gives  to  the  skin  a  greasy  look.  I  have 
asked  my  physician  about  the  cause,  thinking  perhaps  it  was 
an  impurity  of  the  blood.  But  he  claims  it  is  not,  and  that 
he  knows  of  nothing  to  remedy  it.  I  have  kept  the  pores  of 
the  skin  of  the  whole  body  open  by  frequent  bathing,  think- 
ing that  might  be  of  benefit.  Sometimes  she  has  little  eleva- 
tions which  are  like  little  pimples,  but  when  they  are  squeezed 
out  it  is  just  the  same  fatty  substance  which  exudes — not  pus. 
I  would  state  that  her  diet  has  been  carefully  watched,  and 
only  the  simplest  food  allowed.  Are  these  appearances  of  the 
skin,  especially  the  little  fatty  pimples,  due  to  the  state  of 
the  blood?  What  course  of  treatment  could  you  advise  me  to 
pursue  in  order  to  have  the  pores  of  my  little  girl's  face  clean, 
pure,  and  healthy? 

The  ailment  is  easily  recognized.  The  medical  name  of  the 
eruption  is  comedo.  The  natural  sebaceous  follicles  are  filled 
or  distended  with  their  secretion  (sebum) ,  and  the  dark  head 
is  caused  by  the  deposit  of  dust,  or  possibly,  as  some  think, 
by  a  formation  of  pigment.  The  situations  most  generally 
affected  are  the  nose  and  its  neighborhood,  the  forehead  and 
temples,  and  the  upper  part  of  the  back. 

Constitutional  treatment  is  sometimes  necessary,  but  ordi- 
narily purely  local  treatment  suffices.  It  consists  first  of 
squeezing  out  the  contents  of  the  follicles.  This  may  be  done 
with  finger-nails,  better  by  means  of  a  large  watch-key,  or, 
still  better,  a  small  cylindrical  tube  with  a  smooth  end,  which 
is  less  likely  to  injure  the  skin.  The  hollow  end  is  placed 
over  the  "black-head,"  and  smart,  abrupt  pressure  forces 
the  latter  out  of  the  follicle. 

Directly  after  the  use  of  the  instrument  on  the  various 
points  the  parts  are  to  be  bathed  with  hot  water  to  diminish 
the  irritation.  In  addition,  the  glands  are  to  be  stimulated 
by  the  daily  use  of  good  soap.  If  this  proves  too  irritating, 
warm  bran- water  in  which  a  little  borax  is  dissolved  may  be 
used.     If  the  skin  is  unpleasantly  shiny  after  the  use  of  soap, 

18 


274       THE  CENTURY  BOOK  FOR  MOTHERS 

rub  it  with  a  soft  flannel  or  lightly  powder  it.  But,  except 
among  ladies,  this  shininess  of  the  skin  is  rarely  considered 
worth  notice. 


THE   CAUSE   AND   CURE   OF   HIVES 

Will  you  kindly  tell  me  if  there  is  any  cure  for  hives?  I  have 
a  little  boy,  now  eighteen  months  old,  who  is  perfectly  healthy 
in  every  respect,  but  is  greatly  troubled  with  hives,  and  has 
been  since  his  birth.  He  has  only  commenced  to  take  solid 
food  within  the  last  two  months.  I  can't  observe  that  his  diet 
has  much  to  do  with  it.  He  appears  to  inherit  the  trouble 
from  me. 

It  should  be  mentioned  that  the  term  ^' hives"  is  a  popular 
name  for  several  disorders  of  widely  different  character. 
First,  it  means  croup,  especially  catarrhal  croup.  This  appli- 
cation of  the  term  seems  to  be  not  common  in  America,  but  it 
survives  in  the  popular  remedy  for  croup  now  passing  out  of 
use— "hive-syrup."  Secondly,  the  name  is  applied  to  vari- 
ous skin  eruptions,  and  particularly  to  urticaria,  or  nettle- 
rash.  In  answering  we  shall  assume  that  this  last  is  the  dis- 
ease meant  by  our  correspondent. 

Both  the  scientific  and  popular  names  just  mentioned  are 
derived  from  that  of  the  stinging  nettle  (several  species  of 
urtica),  which  produces  this  eruption  if  it  touches  the  skin, 
at  least  in  many  persons.  The  eruption  is  composed  of 
wheals,  raised  above  the  surface  a  sixteenth  of  an  inch  or 
more,  which  are  white  or  pink  and  surrounded  by  a  red 
blush.  Ordinarily  they  are  not  much  larger  than  a  finger- 
end  or  a  cent;  in  severe  cases  they  form  large  patches,  and 
it  is  not  rare  to  see  the  face  swollen  by  them  until  it  resem- 
bles the  face  of  one  afflicted  with  an  erysipelatous  inflam- 
mation. The  outbreaks  are  usually  quite  sudden,  and  often 
they  as  quickly  subside.  Many  persons  are  very  subject  to 
the  disorder,  particularly  those  of  a  nervous  temperament. 

The   causes  are  various.      External  irritations   of   many 


ERUPTIONS  275 

kinds  may  excite  it.  Besides  the  nettle,  which  stings  by  its 
minute  sharp  hairs,  many  stinging  insects  cause  it.  A  stroke 
of  a  whip-lash  is  a  well-known  instance  of  an  external  irri- 
tant causing  the  wheal.  We  have  seen  persons  whose  skin, 
particularly  after  a  bath,  would  rise  in  the  track  of  a  sim- 
ple pressure  of  a  finger-tip.  The  skin  of  some  persons  is 
chronically  in  this  state  of  excitability. 

Internal  causes  are  also  very  various.  Most  common  of 
all  is  a  sensibility  to  certain  things  taken  into  the  stomach, 
some  of  which  affect  many  persons.  Of  these  the  most  fa- 
miliar are  fish,  oysters,  clams,  lobsters,  crabs,  and  berries, 
notably  strawberries.  Less  frequently  vegetables,  such  as 
cucumbers  and  mushrooms,  may  be  the  offending  food,  and 
some  persons  are  affected  by  eggs  or  honey.  Many  persons 
are  affected  only  at  certain  seasons  or  occasionally,  others 
pretty  uniformly  by  some  particular  article  of  diet.  The 
peculiarity  does  not  seem  to  be  always  connected  with  an 
indigestion,  as  the  effect  is  sometimes  too  prompt,  occurring 
almost  before  the  food  is  swallowed.  There  are  many  drugs 
which  produce  urticaria  in  susceptible  people. 

Now,  to  effect  a  cure  is  often  extremely  difficult;  often, 
on  the  other  hand,  very  easy.  This  depends  in  part  upon 
the  varying  character  of  the  ailment  as  to  pertinacity  and 
upon  the  good  fortune  of  the  physician  in  ascertaining  what 
is  the  particular  cause  in  any  given  case.  The  successful 
remedies  may,  for  the  greater  part,  be  classed  under  three 
heads:  (1)  Those  which  clear  the  intestinal  canal  of  the 
offending  substance,  if  food  seems  to  be  the  cause  of  the 
trouble.  The  household  remedy  of  rhubarb  and  soda,  or 
rhubarb  and  magnesia,  maintains  its  place  among  such.  (2) 
Remedies  which  act  as  antiseptics  upon  imperfectly  digested 
or  fermenting  food.  Among  the  most  popular  of  these  are 
sodium  salicylate  and  sulphurous  acid,  or  the  sulphites.  (3) 
In  cases  more  or  less  chronic,  tonics,  especially  Peruvian  bark 
and  its  derivatives,  are  very  useful. 

For  the  temporary  alleviation  of  the  itching,  sponging 
with  an  alkaline  solution  (soda  and  water),  or  with  alcohol, 


276       THE  CENTURY  BOOK  FOR  MOTHERS 

or  the  rubbing  on  of  an  ointment  containing  chloroform, 
seems  to  be  as  successful  as  anything  we  know. 

The  main  point,  however,  is  to  find  out  the  cause,  and  in 
the  case  of  your  baby  we  think  the  most  probable  source  of 
mischief  lies  in  the  intestinal  canal.  An  occasional  clearing 
out  of  the  bowels  with  the  rhubarb  and  soda,  and  possibly 
a  tonic,  will  be  the  safest  plan. 


IX 
COMMON   DISEASES 

PRECAUTIONS   IN   A   CASE   OF   DIPHTHERIA 

Our  little  three-year-old  daughter  is  just  recovering  from  a  se- 
vere attack  of  croupal  diphtheria.  She  is  hoarse  and  coughs 
a  good  deal.  Her  stomach  troubles  her,  and  she  is  very  rest- 
less at  night.  She  eats  very  little,  mostly  milk  with  bread  or 
oatmeal  gruel  strained.  I  know  nothing  about  the  after- 
treatment  of  diphtheria.  Perhaps  you  could  enlighten  me  on 
the  following  points: 

How  long  is  it  before  the  danger  of  infection  is  over?  We 
have  kept  our  baby  away  from  her,  and  it  is  now  one  week 
since  she  began  to  mend. 

How  long  does  the  throat  remain  inflamed  usually  and  the 
hoarse  cough  continue?     She  cannot  speak  plainly  yet. 

What  are  the  symptoms  of  a  relapse? 

What  is  the  best  preventive  against  the  infection  of  others  and 
also  the  recurrence  of  the  disease  with  every  cold,  etc.  Some 
recommend  belladonna. 

In  case  of  paralysis  and  other  after-troubles,  what  is  best  to 
do  until  medical  aid  can  be  procured? 

Is  a  change  of  climate  always  desirable  when  it  can  be  had? 

No  one  can  answer  this  question  categorically.  Assum- 
ing a  genuine  diphtheria,  contagion  is  possible  as  long  as 
any  of  the  poison  is  about,  and  it  may  cling  to  clothing  or 
articles  of  furniture  for  a  long  time.  After  the  sick  child 
is  pronounced  thoroughly  well  it  should  be  carefully  bathed, 

277 


278        THE  CENTURY  BOOK  FOR  MOTHERS 

its  hair  cleaned,  and  its  clothing  all  changed,  and  taken  to 
another  room— not  yet  to  other  children— while  the  sick-room 
and  its  contents  are  fully  disinfected.  The  child  should 
be  kept  away  from  other  children  for  some  days  longer  at 
least. 

Often  a  long  time— the  time  is  so  variable  that  to  state 
an  average  would  be  rather  a  guess  than  a  rule. 

A  real  relapse  consists  in  the  reappearance  of  a  mem- 
brane somewhere.  If  it  is  low  down  in  the  throat  the  symp- 
toms may  be  those  of  croup.  If  higher  up,  or  on  the  ton- 
sils, or  in  the  front  part  of  the  nostrils,  the  membrane  can 
be  seen,  or  if  high  in  the  nostrils  it  can  be  inferred  from  the 
kind  of  discharge.  Scientifically  speaking,  there  is  a  relapse 
or  reinfection  whenever  the  bacillus  of  diphtheria  reappears 
in  any  of  the  mucous  surfaces  after  having  once  been  absent. 
These  bacilli  often  persist,  however,  for  a  long  time  after 
apparent  recovery.  The  case  is  not  cured  so  long  as  they 
persist,  and  it  may  still  cause  infection  of  others.  Until  ' '  a 
clean  culture"  is  obtained  the  case  is  dangerous. 

The  disinfection  and  care  described  above  is  the  best  safe- 
guard. There  is  no  tendency  for  it  to  come  back  "with 
every  cold,"  unless  the  poison  of  diphtheria  is  lurking 
around.  Belladonna  probably  has  absolutely  no  effect  on  the 
poison.     It  is,  however,  useful  for  some  sore  throats. 

The  domestic  treatment  of  the  paralysis  is  practically  noth- 
ing, except  nutrition— careful  feeding  little  by  little  to 
avoid  choking,  if  the  throat  is  the  seat  of  the  paralysis.  For 
the  paralysis  of  the  limbs  w^e  know  of  no  domestic  treatment 
to  be  recommended. 

A  change  of  climate— to  a  healthful  one— if  the  change 
can  be  accomplished  without  too  great  fatigue,  usually  is  of 
value  in  promoting  recovery  from  debilitating  ailments.  It 
is  not  called  for  in  diphtheria  more  than  in  other  diseases,  but 
change  might  prove  beneficial  by  removing  the  patient  from 
the  influence  of  the  special  poison  which  had  been  left  unde- 
stroyed  in  the  home,  and  which  often  causes  reinfections,  as 
shown  by  cultures  made  from  the  throat. 


COMMON   DISEASES  279 


GENERAL   EXPERIENCES  WITH   ANTITOXIN 

What  is  the  present  status  of  antitoxin  as  a  remedy  against 
diphtheria?  One  sees  so  many  contradictory  accounts  of  its 
effects  in  the  newspapers  that  an  authoritative  opinion  will 
doubtless  be  welcome  to  many  readers. 

This  is  about  the  present  status:  As  regards  the  results  in 
hospital  practice  there  is  some  disagreement,  but  we  believe 
that  the  prevailing  opinion  is  distinctly  in  its  favor.  Some 
of  the  most  active  antagonists  of  the  use  of  antitoxin  seem 
to  have  made  up  their  minds  in  advance  of  experience,  and 
to  have  collected  only  such  evidence  as  v^ould  aid  their  pre- 
conceptions. 

Some  time  ago  the  American  Pediatric  Society,  believing 
that  the  real  test  of  the  value  of  the  remedy  would  be  made 
in  private  practice,  determined  to  collect  all  the  evidence  it 
could  concerning  its  use  by  general  practitioners.  At  the 
meeting  of  the  society  in  Montreal  the  committee  reported 
the  results  of  the  investigation.  Several  hundred  physicians 
had  contributed  their  experience.  All  doubtful  cases  of 
diphtheria  were  omitted,  leaving  about  fifty-five  hundred  un- 
mistakable ones.  The  results  were  very  encouraging  indeed, 
and  the  most  enthusiastic  reports  were  from  practitioners 
whose  previous  experience  had  been  most  disastrous. 

It  is  not  pretended  that  the  antitoxin,  even  of  the  best 
quality,  is  a  "sure  cure"  for  diphtheria.  There  are  many 
reasons  why  it  cannot  be ;  but  that  it  is  a  very  potent  remedy, 
outweighing  in  value  any  other,  and  probably  all  others,  as 
against  the  disease  per  se,  now  seems  a  fair  statement.  It 
does  not  and  should  not  displace  all  other  proper  treatment, 
medical  and  surgical,  but  it  does  make  its  results  more  favor- 
able, and  nowhere,  we  think,  is  this  more  striking  than  in 
cases  of  diphtheria  of  the  larynx,  where  some  interference 
on  the  part  of  the  attendant  has  become  necessary.  In  this 
connection  the  society  above  mentioned  collected  further  evi- 
dence, with  similarly  reassuring  results. 


280  THE  CENTURY  BOOK  FOR  MOTHERS 

ANTITOXIN   AS   A   PREVENTIVE   AND   CURE 

What  is  your  opinion  of  the  value  of  antitoxin  as  a  preventive 
of  diphtheria?  Do  you  approve  of  giving  it  in  all  cases  of 
diphtheria  ? 

The  value  of  antitoxin  is  more  manifest  every  year.  With 
the  early  recognition  of  the  disease  by  bacterial  culture,  and 
the  prompt  use  of  antitoxin  in  all  suspected  cases,  the  death- 
rate  from  diphtheria  has  been  wonderfully  reduced ;  for  in- 
stance, in  the  city  of  Boston  to  less  than  ten  per  cent.  The 
efficiency  of  the  antitoxin  is  very  much  greater  if  given  early 
—that  is  to  say,  as  a  preventive  of  the  development  of  the 
poison  in  the  system,  than  as  a  cure  for  its  ravages.  Its 
value  as  a  preventive  of  the  disease  in  those  exposed  but  not 
manifestly  infected  is  fully  demonstrated.  To  the  writer's 
mind,  the  use  of  the  antitoxin,  if  obtainable,  is  imperative 
in  all  cases  of  diphtheria,  and  also  in  all  threatening  cases 
in  which  the  diagnosis  has  to  wait  for  bacteriological  proof. 


QUESTIONS   AS   TO   DIPHTHERIA   AND   MEMBRANOUS 

CROUP;   POPULAR   MISCONCEPTION 

OF   MEDICAL   TERMS 

Is  there  any  difference  between  diphtheria  and  membranous 
croup,  and  is  the  latter  contagious?  And  is  it  only  allopathic 
physicians  who  consider  them  identical? 

We  may  say  at  starting  that  so  far  as  we  know  there  never 
was  any  school  of  physicians  calling  themselves  allopathic 
or  allopaths.  But  by  a  singular  misuse  of  words  the  name 
is  popularly  applied  to  those  who  do  not  accept  the  doctrines 
of  homoeopathy  or  any  other  pathy.  The  special  point  asked 
about  has  never  to  our  knowledge  been  made  a  distinctive 
one  between  any  schools  of  medicine. 

The  identity  of  diphtheria  and  membranous  croup  has 
1  een  very  much  discussed  for  many  years,  and  the  opinion 


COMMON  DISEASES  281 

has  varied  very  much  with  time.  Physicians  who  were  in 
practice  about  thirty-five  years  ago— the  time  that  diphtheria 
first  reappeared  in  this  country  after  a  very  long  absence- 
pretty  generally  considered  it  as  a  very  different  disease 
from  the  then  well-known  membranous  croup.  As  time  has 
passed,  this  opinion  has  lost  ground,  and  has  nearly  dis- 
appeared. We  doubt  if  the  question  can  be  absolutely  de- 
cided. But  without  any  intention  or  desire  to  dogmatize, 
we  may  say  that  our  own  notion  is  this:  That  the  mem- 
branous croup  of  forty  years  ago  was  not  diphtheritic  in  our 
present  sense  of  a  disease  due  to  the  Klebs-Loeffler  bacillus ;  it 
was  rather  a  rare  disease  as  compared  with  diphtheria  to- 
day, and  the  evidence  of  its  contagiousness  was  wanting. 
On  the  other  hand,  to-day  a  membranous  laryngitis  (croup) 
is  practically  always  diphtheritic,  the  change  probably  being 
due  to  the  general  diffusion  of  the  diphtheria  poison.  There 
are  many  kinds  of  sore  throat  characterized  by  a  membrane- 
like exudation,  concerning  the  nature  of  which  a  good  deal 
of  doubt  and  difference  of  opinion  exists  among  those  well 
qualified  to  judge.  Thus,  there  are  many  cases  which  every 
one  pronounces  diphtheria ;  other  cases  which  every  one  is 
equally  sure  are  non-diphtheritic;  but  between  are  many 
kinds  of  tonsilitis  concerning  which  a  guarded  opinion  must 
be  given,  unless  one  takes  the  short  and  easy  method  of  class- 
ing them  all  together  as  diphtheria— a  method  which  tends  to 
magnify  the  repute  of  the  user,  as  a  vast  majority  of  his 
cases  will  get  well. 

We  may  mention  one  term  only  to  condemn  it:  It  is 
''diphtheritic  sore  throat."  If  any  disease  is  diphtheritic  it 
is  diphtheria;  if  it  is  not  diphtheria  it  is  not  diphtheritic. 
If  the  physician  is  not  sure  of  its  nature  he  should  have  the 
courage  and  honesty  to  say  so,  and  not  hide  behind  a  tricky 
phrase.  The  danger  of  using  it  lies  in  the  proneness  of  peo- 
ple to  be  misled  by  a  meaningless  name,  and  neglect  necessary 
precautions.  Every  doubtful  case  of  throat  disease  should 
be  treated  as  dangerous  until  a  culture  proves  it  to  be  not  so. 

In  leaving  the  subject,  we  may  mention  a  similar  dan- 


282  THE  CENTURY  BOOK  FOR  MOTHERS 

gerous  blunder  in  the  supposition  that  scarlatina  is  a  mild 
or  innocuous  form  of  scarlet  fever.  Scarlatina  is  simply  the 
Latinized  technical  name  for  scarlet  fever ;  the  blunder  prob- 
ably arises  from  mistaking  the  termination  '^ina"  for  a  di- 
minutive. Scarlatina  is  neither  more  nor  less  than  scarlet 
fever. 

CROUP 

Please  state  the  difference  between  false  croup  and  real  croup. 
There  seems  to  be  much  confusion  on  the  subject.  Many  per- 
sons speak  of  "croup"  simply,  when  evidently  false  only  is 
meant.  Is  not  the  real  croup  a  very  dangerous  sickness,  and 
false  croup  a  comparatively  harmless  one? 

Any  disorder  which  produces  a  peculiar  change  in  the  sound 
of  the  voice  and  the  cough,  and  which  is  attended  with  more 
or  less  difficulty  of  breathing,  is  called  croup.  But  the  kinds 
usually  thought  of  when  the  name  is  used  are  the  catarrhgd 
or  ''false"  croup,  and  the  membranous  or  ''true"  croup. 
The  term  "spasmodic"  croup  is  applied  properly  to  a  spas- 
modic disease  of  the  larynx  {laryngismus  stridulus,  or  "child 
crowing"),  but  carelessly  to  the  "false"  croup  mentioned 
above.  The  "false"  croup  is  a  catarrhal  laryngitis,  and  the 
symptoms  are  due  to  the  temporary  changes  in  the  mucous 
membrane  of  the  parts.  It  is,  as  you  suppose,  attended  with 
more  alarm  than  real  danger.  In  "true"  croup  a  fibrous 
membrane  forms  in  the  larynx  or  windpipe,  upon  the  surface 
and  more  or  less  in  the  substance  of  the  mucous  membrane. 
This  membranous  croup  is  at  the  present  time  usually  con- 
sidered to  be  of  diphtheritic  origin,  and  some  physicians  be- 
lieve that  it  always  is  and  always  was  diphtheritic,  but  this 
is  a  disputed  point.  This  "true"  croup  is  a  very  dangerous 
disease.  Besides  the  dangers  from  obstruction  in  the  larynx 
and  windpipe,  it  entails  all  the  other  dangers  of  diphtheria. 
The  "false"  croup  is  one  of  the  manifestations  of  a  "cold" 
in  some  children— called  popularly  "croupy."  It  is  cer- 
tainly more  likely  to  occur  in  improperly  fed  children. 


COMMON  DISEASES  283 

The  term  ''croupous"  is  in  medical  parlance  applied  to 
a  fibrinous  exudation  occurring  on  a  mucous  membrane  in 
any  situation ;  thus,  that  type  of  pneumonia  which  has  such 
an  exudation  is  called  croupous  pneumonia. 

CHARACTERISTICS   OF   MALARIAL   DISORDERS 

Can  you  tell  me  what  is  the  matter  with  my  little  girl?  She  is 
two  and  a  half  years  old,  and  large  and  strong  for  her  age,  but 
on  several  occasions  she  has  complained  early  in  the  afternoon 
of  feeling  very  tired,  and  has  wanted  to  lie  down ;  she  has  then 
become  very  sleepy  and  flushed,  and  has  nearly  got  into  a 
kind  of  stupor,  lying  with  her  head  and  face  almost  buried  in 
her  pillow,  and  with  her  knees  drawn  up  to  her  chest;  this  is 
accompanied  with  fever,  and  every  now  and  then  she  has  been 
sick  at  her  stomach,  and  has  then  fallen  off  again  into  the 
same  state,  from  which  no  noise  will  rouse  her;  toward  night 
she  gets  cooler,  and  in  the  morning  wakes  up  much  better  and 
quite  bright,  but  still  a  little  flushed  and  feverish.  She  has 
had  these  attacks  three  times ;  the  second  time  it  lasted  a  week, 
and  every  day  was  nearly  a  repetition  of  the  previous  one;  the 
last  attack  lasted  about  two  or  three  days. 

I  have  had  a  doctor's  advice,  but  with  apparently  little  result, 
and  I  should  like  to  know  what  is  really  the  matter,  as  I  fear 
a  recurrence  of  the  attack.  I  feed  the  child  on  meat  every 
second  day,  and  only  give  a  little  of  it  to  her  with  potato;  her 
other  diet  consists  of  bread  and  milk  and  bread  and  butter, 
with  light  puddings,  and  nothing  else.  The  strange  part  of 
the  attack  is  this  repetition  of  the  fever  and  sickness  at  the 
same  hour  each  day,  and  the  apparent  entire  relief  from  it  in 
the  morning. 

The  stupor  and  other  symptoms  doubtless  depend  upon  the 
rise  of  temperature.  This  may  be  due  to  a  multitude  of 
causes.  But  the  distinct  periodicity  of  the  attack  would 
make  the  diagnosis  of  intermittent  fever  a  very  probable 
one,  although  as  regards  children  we  are  very  shy  of  using 
the  words  ''intermittent,"  "remittent,"  or  "malarial,"  as 
they  are  made  the  cloak  of  a  world  of  ignorance.     Intermit- 


284  THE  CENTURY  BOOK  FOR  MOTHERS 

tent  fever  is  the  most  distinct  of  malarial  disorders.  In  a 
typical  case  in  an  adult  the  chill  which  announces  a  paroxysm 
occurs  with  considerable  regularity— daily,  on  alternate  days, 
or  less  often,  according  to  the  variety  of  the  fever.  A  fever 
with  a  daily  access  is  called  a  quotidian  ague ;  one  with  an 
access  on  alternate  days  is  a  tertian  ague,  and  so  on.  But 
in  childhood  the  frank  chill  is  less  common  and  the  fever  is 
less  regular  than  in  adults.  And  herein  lies  the  danger  of 
error,  since  in  most  diseases  of  childhood  the  temperature  is 
more  subject  to  fluctuations  than  in  adults.  An  irregular  or 
paroxysmal  fever  may  arise  from  a  multitude  of  causes,  and 
may  be— indeed,  often  is— classed  as  ''malarial"  or  "remit- 
tent" simply  from  the  temperature  range,  while  the  mala- 
rial poison  has  nothing  whatever  to  do  with  it,  and  the  real 
cause  behind  the  fever  may  be  overlooked  and  its  treatment 
therefore  neglected.  Many  physicians  do  not  in  a  doubt- 
ful case  make  a  diagnosis  of  malarial  disease  until  they 
have  after  proper  search  failed  to  find  any  other  reasonable 
cause. 

Fortunately,  the  true  malarial  fevers  are  usually  quite 
amenable  to  medical  treatment,  and  quite  recently  it  has  be- 
come possible  by  examination  of  the  blood  to  make  a  clear  or 
probable  diagnosis  in  cases  formerly  very  difficult  of  deter- 
mination. 

REMEDIES  FOR  MALARIAL   FEVER 

I  have  a  baby,  nine  months  old,  who  for  almost  two  weeks  has 
had  chills  every  other  day.  I  had  one,  and  I  suppose  he  took 
the  start  from  me,  but  he  still  has  them.  I  have  taken  an 
abundance  of  quinine,  and  have  rubbed  him  with  it,  and  the 
day  before  his  last  one  I  had  the  doctor  inject  some  in  his 
arm  and  give  him  a  solution  of  quinine  three  times,  but  it 
did  not  keep  the  chill  off.  However,  I  will  give  him  more  of 
it  again.  I  hate  so  much  to  give  quinine;  the  acid  put  in 
to  dissolve  it  curdles  his  milk,  and  it  is  such  a  fearful  dose 
to  take.  I  would  like  to  know  if  there  is  not  something  more 
simple  that  will  do  the  same  good.  I  have  always  nursed  him, 
and  he  has  always  been  well.     Before  he  was  sick  he  weighed 


COMMON  DISEASES  285 

twenty-four  pounds,  which  I  think  is  good  weight  for  a  baby 
of  that  age. 

There  is  no  meaning  that  we  can  understand  connected  with 
the  adjective  "simple"  as  popularly  applied  to  remedies. 
The  ancient  meaning  of  a  ''simple"  remedy  was,  as  nearly 
as  may  be  expressed,  an  herb  or  vegetable  remedy  supposed 
to  have  a  "simple"  or  specific  curative  power  over  some  dis- 
ease or  upon  some  organ.  The  bark  from  which  quinine  is 
gained  would  have  been  a  typical  example.  But  (and  this 
is  why  we  emphasize  it)  practitioners  are  not  a  little  both- 
ered by  importunities  for  some  "simple"  remedy  to  do  this 
or  that,  the  meaning  being,  so  far  as  can  be  guessed,  to  ask 
for  a  remedy  which  shall  be  very  potent  against  the  disease 
or  unpleasant  symptoms,  but  entirely  devoid  of  any  other 
effect.  All  of  which  is  as  wise  as  the  seeking  for  a  gunpow- 
der which  shall  be  of  the  greatest  power  in  propelling  the 
ball  and  which  shall  produce  no  recoil  of  the  gun. 

As  applied  to  your  case,  this  means  that,  while  quinine  is 
in  many  ways— to  some  more  than  to  others— a  remedy  of 
very  disagreeable  action,  yet  it  and  the  kindred  alkaloids 
associated  with  it  in  Peruvian  bark  are,  far  and  away,  the 
best  remedies  we  have  against  malarial  fever.  It  may  be 
mentioned  that  the  hydrochlorate  (muriate)  of  quinine  can 
be  dissolved  without  the  aid  of  acid.  Yet  the  bark  and  its 
derivatives  sometimes  fail,  for  reasons  not  easy  to  under- 
stand. The  remedies  next  in  esteem  are  arsenic,  Warburg's 
tincture,  blue  gum,  probably  in  about  the  order  named. 
It  is  very  difficult  in  many  cases  to  break  up  a  malarial 
fever  while  the  patient  remains  in  the  region  where  the  dis- 
ease has  been  acquired.  But  patience  with  the  treatment 
wdll  probably  effect  a  cure.  It  is  probable  that  a  more  gen- 
eral recognition  of  the  agency  of  certain  mosquitoes  as  the 
conveyers  of  a  malarial-poisoning  organism  will  render  it 
easier  to  prevent  these  persistent  occurrences.  So  far  as  we 
now  know,  malarial  poisoning  always  started  (not  counting 
relapses)  from  the  bite  of  a  mosquito. 


286  THE  CENTURY  BOOK  FOR  MOTHERS 

THE   CAUSES   AND   TREATMENT   OF  TYPHOID   FEVER 

I  should  be  glad  to  have  your  opinion  about  the  general  treat- 
ment of  those  who  have  had  typhoid  fever,  and  to  know  if  you 
think  that  there  is  any  special  care  required,  say,  six  or  seven 
months  after  recovery,  either  with  grown  persons  or  chil- 
dren. 

While  on  this  subject  can  you  advise  me  where  to  get  any  know- 
ledge of  how  typhoid  fever  is  caused  or  taken?  It  seems  to 
me  that  the  treatment  of  typhoid  has  made  wonderful  strides, 
but  as  far  as  I  can  judge  from  my  experience  with  the  faculty, 
they  are  as  far  from  knowing  the  origin  of  typhoid  in  the 
patient  as  ever.  It  is  said  that  it  must  be  taken  inwardly,  as 
through  milk  or  butter  or  something  of  that  kind;  and  others 
say  from  the  excrement.  Many  cases,  however,  have  been 
known  where  it  was  from  none  of  these. 

The  recovery  after  typhoid  seems  in  some  cases  to  be  pretty 
prompt.  Often,  however,  it  is  very  slow,  taking  months,  and 
even  years,  before  the  last  traces  of  its  damage  are  gone. 
Each  case  must  be  judged  by  itself,  and  the  error,  if  any, 
should  be  on  the  safe  side. 

Any  recent  work  on  the  practice  of  medicine  will  prob- 
ably tell  you  all  you  need  to  know— not  a  controversial  pam- 
phlet, but  a  text-book  ''up  to  date,"  which  is  meant  for  the 
use  of  practitioners.  Probably  you  could  borrow  one  from 
your  own  physician.  We  think  the  origin  of  typhoid  fever 
is  much  better  known  than  anything  else  about  it.  We  know 
that  it  comes  from  just  one  poison,  and  we  know  by  sight 
the  peculiar  bacillus  which  is,  or  which  manufactures,  that 
poison.  The  method  bj^  which  that  poison  is  introduced 
into  the  system  in  a  given  case  may  be  uncertain,  but  often 
when  we  are  acquainted  with  the  surroundings  of  the  patient 
in  the  past  the  doubts  are  solved.  Unfortunately,  in  a 
great  proportion  of  cases,  even  in  intelligent  circles,  nothing 
accurate  can  be  learned  as  to  where  the  patient  had  been  or 
what  he  had  done.  It  is  true  that  the  poison  is  mainly,  al- 
most exclusively,  passed  from  the  body  in  the  stools;  it  is 


COMMON  DISEASES  287 

true  that  infection  of  water  and  food  is  generally  through 
infected  stools.  The  links  are  often  lost,  but  in  cases  where 
epidemics  have  been  sufficiently  important  to  excite  research 
it  has  almost  uniformly  been  found  that  the  circle  has  been: 
An  initial  case;  infected  stools  so  disposed  of  as  to  infect 
water;  this  water,  drunk  or  mixed  with  food  or  used  to 
wash  vessels  to  be  used  for  food.  A  recent  epidemic  in  a 
town  near  New  York  was  confined  to  the  patrons  of  one  milk- 
man, whose  premises  were  found  to  be  infected.  Sadly 
enough,  some  of  the  patients  confined  themselves  to  a  diet  of 
the  very  milk  which  was  bringing  them  the  poison,  before  it 
was  discovered.  One  case,  it  is  said,  occurred  in  a  person 
not  a  patron  of  this  dairy,  but  he  had  drunk  milk  when 
taking  a  meal  at  the  house  of  a  patron.  Suppose  this  person 
had  gone  elsewhere  before  sickening,  and  that  the  epidemic 
had  not  been  sufficiently  important  to  awaken  inquiry,  a 
fresh  epidemic  might  have  been  started,  the  origin  of  which 
would  possibly  have  remained  a  mystery.  Similarly,  we 
have  had  epidemics  from  oysters  taken  from  the  water  near 
the  mouths  of  drains. 

SYMPTOMS   OF   TYPHOID   FEVER 

Please  tell  me  something  of  the  symptoms  of  typhoid  fever. 
In  what  way  do  they  differ  from  the  symptoms  of  ordinary 
fever  ? 

As  the  phrase  *' ordinary  fever'*  conveys  no  meaning  to  the 
writer,  the  symptoms  of  typhoid  only  can  be  mentioned. 
These  have  been  well  studied  in  adults,  and  in  them  make  a 
pretty  distinct  picture  of  disease.  The  principal  symptoms 
of  the  onset  of  typhoid  are  decided  lassitude,  with  headache, 
coated  tongue,  and  loss  of  appetite,  and  very  often  with  nose- 
bleed, the  severity  of  the  symptoms  increasing  gradually  until 
after  a  few  days  or  a  week  the  patient  is  obliged  to  take  to 
the  bed.  The  temperature  meantime,  and  perhaps  for  a  week 
longer,  gradually  climbs,  rising  at  night,  letting  up  a  little 


288  THE  CENTURY  BOOK  FOR  MOTHERS 

mornings,  but  with  a  gradual  ascent  which  has  been  com- 
pared to  a  flight  of  steps.  There  are  usually  abdominal 
symptoms,  such  as  gurgling  and  tenderness,  often— probably 
more  often  than  not— diarrhoea  and  about  as  frequently  a 
peculiar  eruption  of  rose-colored  spots,  especially  on  the  back 
and  abdomen.  Let  this  slight  sketch  stand  for  the  adult 
type  of  typhoid.  The  infantile  type  varies  from  it  con- 
siderably. 

In  the  first  place,  typhoid  is  of  exceeding  rarity  under 
the  age  of  two  years.  From  that  to  five  it  is  still  excep- 
tional, but  from  five  to  ten  years  it  is  not  uncommon,  and 
after  this  later  date  the  type  is  nearly  the  same  as  that  of 
adult  life.  But  the  cases  which  occur  between,  say,  two  and 
ten  years— both  dates  approximately  stated— have  the  peculi- 
arities which  are  usually  considered  distinctive  of  typhoid 
much  less  pronounced.  The  fever,  for  instance,  is  less  likely 
to  come  on  with  the  insidious  ascent  before  described.  It 
is  more  likely  abrupt  in  its  onset.  With  it  are  often  symp- 
toms of  disordered  stomach,  such  as  vomiting,  and  the  case 
might  easily  be  taken  for  an  acute  gastric  disturbance.  The 
diarrhoea  is  more  likely  to  be  absent,  and  if  present  to  be 
mild.  The  eruption  is  less  frequent  and  less  marked,  and 
the  fever  is,  on  the  average,  of  somewhat  shorter  duration 
than  with  older  children  or  adults.  The  depression,  however, 
is  much  the  same. 

It  will  be  seen,  therefore,  that  the  peculiarities  of  typhoid 
in  childhood  are  not  very  striking,  and  the  diagnosis  must 
often  be  made  by  the  physician  by  the  aid  of  blood  tests  and 
the  like.  The  only  lesson  for  the  nursery  guardian  is:  In 
any  case  of  continued  fever  have  medical  advice. 

THE   USUAL   SYMPTOMS   AND   TREATMENT   OF 
SCARLET  FEVER 

Please  describe  the  usual  symptoms  of  scarlet  fever.  How  long 
does  a  simple  case  last,  and  what  is  the  recognized  mode  of 
treating  it? 


COMMON  DISEASES  289 

The  ordinary  striking  symptoms  are  vomiting,  usually  with- 
out nausea,  and  sore  throat,  with  fever.  The  onset  of  symp- 
toms is  sudden.  The  throat,  and  the  roof  of  the  mouth  as 
well,  is  quite  red,  and  in  the  latter  situation  the  redness  is 
made  up  of  very  fine  dots,  much  as  is  the  skin  eruption  when 
it  comes.  The  fever  varies  with  the  severity  of  cases  from 
perhaps  101°  to  105°.  The  eruption  follows  in  a  variable 
time,  but  as  a  rule  it  is  from  a  half -day  to  a  day  and  a  half. 
It  usually  is  first  seen  upon  the  neck  and  breast,  but 
the  whole  skin  should  be  examined.  It  spreads  rather 
quickly  over  the  whole  body,  and  continues  for  a  variable 
time,  but  in  the  great  majority  of  cases  this  time  is  between 
three  days  and  a  week.  The  desquamation  or  peeling  being 
an  essential  part  of  the  disease,  the  latter  must  be  considered 
to  continue  as  long  as  any  desquamation  exists,  which  may 
be  from  one  to  two  months.  Probably  five  or  six  weeks  will 
cover  most  cases. 

There  is  no  recognized  treatment  special  to  this  disease. 
Rest  in  bed  and  the  relief  of  symptoms  as  they  arise  suffice 
for  mild  cases.  The  essentials  of  treatment  in  ordinary  cases 
are  to  meet  symptoms  and  await  their  natural  disappearance. 
Severe  or  complicated  cases  may  call  for  a  great  deal  of  medi- 
cal care.  The  treatment  of  a  case  of  scarlatina  should  never 
be  assumed  by  any  one  without  medical  guidance,  if  the  latter 
be  obtainable.  Baths  are  extensively  used  in  the  treatment 
of  the  disease,  but  even  these  should  be  specifically  directed 
if  possible.  Sequels  follow  even  the  mildest  cases,  and  these, 
as  well  as  the  severe  ones,  should  be  carefully  watched  and 
isolated. 

CHARACTERISTICS   OF   MEASLES 

Can  one  always  tell  whether  a  child  is  going  to  have  measles  or 
scarlet  fever?  What  is  the  best  domestic  treatment  for 
measles  ? 

Measles  usually  begins  with  a  cough  and  catarrhal  symptoms. 
But  these  do  not  show  that  the  child  is  going  to  have  measles, 

19 


290       THE  CENTURY  BOOK  FOR  MOTHERS 

but  that  he  already  has  it.  In  scarlet  fever  the  onset  is 
abrupt.  If,  as  may  be  the  case  among  non-professional  peo- 
ple, only  the  eruptions  are  considered  the  disease,  then  the 
earlier  stages  (see  p.  145)  may  give  the  warning.  But  to 
the  medical  man  these  symptoms  are  as  essential  as  the  rashes. 

The  best  domestic  treatment  is  to  send  for  the  doctor.  If, 
after  examining  the  case  thoroughly,  he  believes  that  it  can 
be  left  to  domestic  care,  he  will  give  directions  as  to  that 
care,  and  also  indicate  the  symptoms  that  will  demand  his 
attention. 

One  of  the  principal  dangers  in  the  treatment  of  even 
mild  cases  of  scarlet  fever  and  measles  without  professional 
guidance  is  the  non-recognition  of  complications  and  sequels. 
Those  in  scarlatina  are  commonest  in  the  shape  of  throat  and 
ear  troubles,  kidney  inflammation,  and  the  so-called  scarla- 
tinal rheumatism.  All  of  these  complications  may  induce 
secondary  ones,  and  the  watching  of  a  case  of  scarlatina  is 
never  a  light  task,  even  to  the  physician. 

The  complications  and  sequels  of  measles  are  more  strik- 
ingly manifested  in  the  respiratory  and  the  digestive  organs. 
Measles  often  awakens  latent  lymphatic  troubles,  and  the  eyes 
may  remain  tender  (chronic  conjunctivitis)  for  a  long  time. 


GERMAN    MEASLES    OR   ROTHELN 

Does  a  child  that  has  German  measles  require  any  treatment? 
Is  this  trouble  always  easy  to  recognize,  or  does  it  not  some- 
times resemble  real  measles? 

This  disease,  of  which  the  scientific  name  is  rubella,  has  been 
definitely  recognized  as  distinct  from  measles  and  scarlatina 
only  in  comparatively  recent  years.  Its  name,  '^German 
measles, ' '  shows  that  it  has  been  considered  a  variety  of  mea- 
sles. In  fact,  it  is  a  disease  by  itself,  although  it  does  resem- 
ble, especially  in  its  eruption,  sometimes  measles,  sometimes 
scarlatina ;  much  more  often  the  former. 

One  of  the  most  striking  peculiarities  of  the  disease  is  its 


COMMON  DISEASES  291 

variability  of  appearance,  and  very  experienced  physicians  are 
often  obliged  to  base  their  diagnosis  rather  upon  the  concomi- 
tant circumstances  and  the  prevalence  of  the  disease  (for  it  is 
one  that  is  rarely,  if  ever,  seen  except  in  epidemics)  than  upon 
the  appearance  or  history  of  the  individual  case.  A  fair  de- 
scription of  an  average  case  would  be  something  like  this :  An 
eruption  is  discovered  on  the  face,  or  even  covering  the  whole 
body,  without  any  previous  signs  of  illness,  although  fever, 
catarrhal  symptoms,  vomiting,  etc.,  may  have  existed.  The 
eruption  consists  of  slightly  raised  reddish  spots,  usually  not 
more  than  an  eighth  of  an  inch  in  diameter.  It  generally 
begins  on  the  face,  runs  over  the  body,  and  goes  off  in  the 
same  order,  and  is  gone  in  about  three  days.  Usually  the 
spots  do  not  run  together  and  the  fever  is  slight,  lasting 
about  two  days.  The  "peeling"  of  the  skin  rarely  amounts 
to  much.  Physicians  usually  expect  to  find  some  swelling 
of  the  glands,  particularly  in  the  back  part  of  the  neck. 

While  exceptions  do  occur,  it  is  true  that  the  disease  rarely 
kills  or  even  is  attended  with  severe  complications  or  after- 
troubles.  Therefore,  if  the  disease  is  certainly  recognized, 
little  treatment  in  the  sense  of  medication  is  called  for.  Pain- 
ful or  distressing  symptoms  may  require  attention.  If  they 
do  not  occur,  good  nursing  will  meet  all  the  requirements. 
But  careful  regimen  and  nursing  go  far  to  prevent  these 
untoward  symptoms  and  complications,  and  should  always  be 
employed.  It  is  obvious  that  isolation  of  the  cases  is  de- 
sirable. 


THE  CAUSES  AND  CHARACTERISTICS  OF  RHEUMATISM 

How  can  one  recognize  rheumatism  in  young  children?     What 
causes  it? 


Rheumatism  is  a  term  of  such  wide  and  vague  meaning  that 
it  has  been  seriously  proposed  to  banish  it  from  medical 
nomenclature.  For  our  purpose  we  will  take  it  to  mean  that 
disorder  known  as  rheumatic  fever,  or  acute  rheumatism. 


292       THE  CENTURY  BOOK  FOR  MOTHERS 

In  adults  this  disease  is  characterized  by  a  good  deal  of  fever, 
painful  and  swollen  joints,  and  many  other  well-known  signs. 
In  children,  especially  if  young,  the  symptoms  are  not  so 
striking.  If  the  child  can  talk,  it  probably  will  complain  of 
soreness  in  joints  or  muscles.  If  it  be  too  young,  it  may  show 
signs  of  pain  on  handling.  There  is  usually  moderate  fever. 
The  symptoms  are  unfortunately  often  overlooked,  or  called 
''growing  pains."  "Growing  pains"  are  pretty  certainly 
something  else  than  what  they  are  called,  and  should  not  be 
neglected,  as  a  sad  lot  of  heart  lesions  come  from  them. 
Whenever  a  child  complains  of  pains,  especially  if  it  has 
tonsilitis  or  a  tendency  to  nervous  twitching  (chorea),  it  is 
fair  to  consider  it  a  case  of  rheumatism.  The  cause  of  rheu- 
matism, according  to  what  we  think  is  to-day  the  prevalent 
opinion  of  those  best  able  to  judge,  is  an  infection,  probably 
microbic.  The  matter  is  still  under  investigation  as  well  as 
discussion. 

THE   CONTAGIOUSNESS   OF   MUMPS 
Is  mumps  a  very  contagious  disease?     What  is  the  treatment? 

It  is  probably  one  of  the  most  contagious  disorders.  Treat- 
ment, beyond  making  the  person  comfortable,  is  rarely  needed 
in  uncomplicated  cases.  As  the  person  cannot  chew^  and 
swallow  without  some  discomfort,  food  should  be  liquid  and 
bland.  Owing  to  the  contagiousness,  the  patient  should,  if 
possible,  be  isolated  until  quite  well.  Unfortunately,  the  con- 
tagiousness seems  to  last  a  long  time. 

THE  VALUE   OF   GARGLING   IN   SORE   THROAT; 
DIFFERENT   KINDS   OF   SORE   THROAT 

Do  you  advise  gargling  for  sore  throat? 

How  can  one  tell  whether  an  ordinary  slight  sore  throat  will 

not  develop  into  a  serious  one? 
Please  mention  the  different  varieties  of  sore  throat  and  their 

symptoms. 


COMMON  DISEASES  293 

Gargling  is  a  convenient  method  of  applying  remedial  liquids 
to  that  part  of  the  throat  which  is  not  far  back.  It  is  of 
small  account  in  the  pharynx.  The  solutions  are  better  ap- 
plied anywhere  by  means  of  an  atomizer  making  a  fine  spray. 

No  one  can  tell.  Some  of  the  points  which  help  to  dis- 
criminate diphtheria  from  other  forms  of  tonsilitis  are  given 
on  page  139. 

The  varieties  of  sore  throat  are  almost  as  numerous  as  the 
infections  causing  disease.  If  divided  according  to  locality, 
there  are  tonsilitis,  pharyngitis,  etc.  If  according  to  appear- 
ance, one  could  divide  again.  Thus,  for  tonsilitis,  there  are 
simple  tonsilitis,  follicular  or  lacunar  tonsilitis,  diphtheritic 
tonsilitis,  suppurative  tonsilitis,  or  quinsy,  etc.  If  accord- 
ing to  cause,  sore  throat  may  be  rheumatic,  gouty,  diphthe- 
ritic, scarlatinal,  etc.  It  is  easy  to  see  that  to  detail  the  symp- 
toms of  each  would  take  a  goodly  chapter. 


ST.   Virus's   DANCE 

Please  describe  the  symptoms  of  St.  Vitus's  dance.     What  is  the 
cure? 

The  one  characteristic  sjrmptom  is  that  with  which  probably 
every  one  is  familiar,  even  in  childhood — namely,  the  erratic 
convulsive  movements  of  the  patient,  winking  of  the  eyes, 
convulsive  twitchings  of  the  face,  jerkings  of  the  hands  and 
arms  as  well  as  of  the  lower  limbs,  and  contortions  of  the 
body.  It  varies  greatly  in  degree.  The  treatment  is  largely 
hygienic,  both  physical  and  mental,  and,  medicinally,  tonic. 
It  is  not  a  good  ailment  for  domestic  experimentation. 


SIGNS  OF   HEART  TROUBLE 

If  a  child  gets  out  of  breath  and  has  sometimes  a  rapid  pulse, 
are  these  signs  of  incipient  heart  trouble?  What  are  the 
usual  symptoms? 


294       THE  CENTURY  BOOK  FOR  MOTHERS 

It  is  not  easy  to  give  precise  answers  to  questions  which  have 
no  precise  meaning.  The  symptoms  mentioned  might  be  due 
to  a  genuine  heart  disease,  meaning  valvular  disease,  or  to  a 
faulty  action  of  the  heart  due  to  anemia,  or  merely  to  the 
excitability  of  the  heart's  action  often  seen  when  the  fault  is 
somewhere  else.  The  term  "incipient"  is  hardly  applicable 
to  heart  diseases— the  genuine  ones. 

ALCOHOLIC  STIMULANTS  IN   FEVERS 

My  little  girl  of  five  years  has  the  scarlet  fever,  and  our  physi- 
cian prescribed  for  nourishment  milk  punches  every  two  hours. 
I  would  like  your  opinion  on  the  subject  of  giving  spirituous 
liquors  to  children  in  cases  of  fever.  I  am  under  the  impres- 
sion that  whisky  and  like  stimulants  only  add  fuel  to  the  fever. 

Alcoholic  stimulants,  properly  used,  do  not  ''add  fuel  to  the 
fever."  The  condition  demanding  their  use  is  not  one  that 
can  be  discussed  without  a  good  deal  of  knowledge  of  physi- 
ology and  pathology.  Every  judicious  physician  considers 
alcohol  as  a  drug  to  be  given  or  withheld  in  any  case,  pre- 
cisely as  any  other  drug,  according  to  the  circumstances  that 
exist  and  the  ends  to  be  accomplished.  The  unfortunate 
abuse  of  alcohol  leads  the  laity  as  well  as  some  physicians 
to  treat  it  as  if  it  were  a  thing  by  itself.  The  abuse  of  opium 
and  other  narcotics,  of  quinine,  or  of  purgatives  is  no  reason 
against  their  proper  medicinal  use.  So  with  alcohol.  If 
you  can  trust  your  physician  with  other  drugs,  you  may  with 
this. 

THE  VALUE  OF  COD-LIVER  OIL  IN  CASES 
OF   SCROFULA 

My  child  is  six  years  old,  very  heavy  and  fat,  but  weak  and  very 
pale.  She  goes  to  a  kindergarten.  Her  appetite  is  queer; 
sometimes  she  eats  very  little  and  sometimes  too  much,  and 
then  mostly  bread,  very  little  or  no  meat,  and  vegetables  none 
whatever.  I  have  doctored  with  her  and  been  to  hospitals. 
The  physicians  say  she  is  scrofulous  and  needs  cod-liver  oil, 


COMMON  DISEASES  295 

and  will  be  stronger  when  she  is  a  year  older.  She  has  always 
had  a  very  bad  cough,  owing  to  bronchitis.  I  have  given  her 
cod-liver  oil  for  over  a  year,  but  notice  no  improvement.  She 
still  coughs  very  badly,  and  at  night  when  she  coughs  she 
sweats.  Is  cod-liver  oil  a  good  remedy  and  the  only  remedy 
in  such  a  case? 

It  is  quite  probable  that  the  opinion  that  has  been  given 
you  is  correct— namely,  that  the  child  is  scrofulous— and  that 
she  has  had,  and  still  has,  bronchitis.  The  rearing  of  such 
a  child  entails  much  patient  care  upon  the  mother,  but  in 
the  end  it  is  usually  successful.  Cod-liver  oil  is  not  the  only 
remedy,  but  is,  perhaps,  more  important  than  any  other  one. 
Besides,  it  would  appear  that  she  should  have  some  remedy 
to  stimulate  the  appetite,  and  to  relieve  the  cause  of  its  fit- 
fulness,  which  probably  is  a  disorder  of  the  stomach.  The 
paleness  suggests  that  she  needs  iron  also.  We  do  not,  how- 
ever, think  it  desirable  for  you  to  try  to  pick  out  the  appro- 
priate medicines  yourself.  It  would  be  better  worth  while 
for  you  to  ask  your  physician  about  these  points. 


A  CASE  OF  TAPE-WORM   IN  A  FOUR-YEAR-OLD  CHILD 

I  am  very  much  troubled  over  a  case  of  "tape-worm."  Our  little 
girl  has  been  troubled  with  this  for  nearly  two  years.  We 
have  given  repeated  treatments  of  fern,  pomegranate,  and 
pumpkin  seed.  Our  physician  does  not  suggest  any  other  rem- 
edy. Can  you  tell  us  of  something  that  will  help  us  in  any 
way?  Are  there  specialists  in  this  line;  if  so,  will  you  kindly 
name  them? 

Please  give  me  all  the  information  concerning  "tape-worm"  that 
you  can — the  best  remedy  and  how  to  apply  it. 

We  may  say  in  starting  that  we  know  of  no  ''specialists"  in 
this  line  among  reputable  physicians.  Some  have  studied 
the  parasites  of  the  human  body  with  great  care,  as  a  matter 
of  science,  but  they  have  promptly  put  their  knowledge  at  the 
disposal  of  the  profession. 


296  THE   CENTURY  BOOK  FOR  MOTHERS 

Three  tape-worms  are  well  knowm  as  living  in  the  human 
intestines.  Of  these  the  broad  tape-worm  is  rare  in  this 
country,  and  practically  is  found  only  in  immigrants  from 
certain  parts  of  Europe.  The  other  two,  called  the  beef  tape- 
worm and  the  pork  tape-worm  (from  their  ordinary  source  in 
human  food),  are  not  uncommon,  the  beef  tape-worm  being 
the  most  frequent  of  all.  The  life  history  of  one  of  these  crea- 
tures is,  in  a  few  words,  this :  The  excrement  of  a  person  suf- 
fering from  tape-worm  is  carelessly  put  upon  fields,  or  in  some 
place  where  cattle  or  hogs  may  swallow  the  embryos  of  the 
worm  contained  in  the  discharges.  After  reaching  the  diges- 
tive tract  of  the  animal  the  development  of  the  embryos  begins, 
and  they  travel  through  the  tissues  until  they  make  a  lodg- 
ment, most  commonly  in  the  flesh  or  liver,  both  used  for  hu- 
man food.  The  flesh  so  infected  is  popularly  called  ' '  measly. ' ' 
If  the  meat  were  thoroughly  cooked  these  partially  devel- 
oped worms  would  die;  but  much  meat  is  eaten  raw  (bologna 
sausages,  etc.)  or  imperfectly  cooked.  The  larva  is  set  free 
in  the  digestive  organs  of  the  person  eating  the  meat  and 
begins  to  grow.  The  differences  in  the  appearances  and  de- 
velopment of  the  two  species  are  too  slight  to  interest  the 
non-professional  reader.  In  fact,  until  quite  a  recent  period 
the  two  were  considered  as  one.  There  is  one  difference,  how- 
ever, worth  mentioning :  The  tape-worm  from  beef  is  usually 
solitary,  of  that  from  pork  quite  often  several  are  found  in  one 
person.  This  fact,  not  generally  insisted  on,  may,  we  think, 
sometimes  explain  the  supposed  failure  of  treatment— that  is 
to  say,  only  one  worm  of  several  has  been  killed,  and  vigi- 
lance relaxed  prematurely.  Probably  only  an  expert  could 
decide  from  small  parts  of  the  worm  to  which  species  it  be- 
longed. The  segments  of  the  pork  worm,  however,  are  usu- 
ally thinner  and  less  opaque  than  those  of  the  beef  worm. 
The  segments  of  the  latter  are  more  likely  to  creep  out  of 
the  bowels  than  are  those  of  the  pork  worm. 

The  three  remedies  you  have  tried  are  all  excellent,  and 
usually  effective.  Besides  them,  kousso  and  oil  of  turpentine 
should  be  mentioned.     The  latter  is  one  of  the  most  certain. 


COMMON  DISEASES  297 

Whatever  remedy  is  selected,  its  use  must  be  preceded  by 
several  days  of  fasting  or  as  scant  a  diet  as  can  be  borne. 
Neglect  of  this  preliminary  often  is  the  cause  of  failure.  The 
dose  of  the  medicine  selected  and  the  preparation  must  be 
determined  by  the  physician  to  suit  the  peculiarities  of  the 
patient,  as  most  of  the  efficient  drugs  have  some  drawbacks 
which  must  be  guarded  against.  It  is  nearly  always  neces- 
sary to  follow  the  administration  of  the  special  remedy  by  a 
purge.  Last  of  all,  it  is  necessary  to  remember  that  after 
many  failures  success  may  be  gained  by  perseverance. 


THE   CAUSES   OF  MENINGITIS 

Will  you  please  state  the  probable  causes  of  meningitis  in  its 
various  forms,  also  whether  there  is  any  safeguard  against  so 
fatal  a  disease  in  young  children? 

In  the  case  of  children  meningitis  is  usually  caused  by  some 
infection.  Probably  the  most  common  is  tubercular.  The 
epidemic  cerebro-spinal  meningitis  seems  to  depend  upon 
several  kinds  of  micro-organisms,  especially  several  kinds  of 
cocci,  including  that  which  causes  pneumonia.  Meningitis 
may  occur  as  a  complication  of  most  of  the  eruptive  fevers, 
influenza,  etc. 

The  only  preventive  is  the  avoidance  of  the  diseases  with 
which  it  is  associated  or  which  it  follows. 

Injuries  to  the  head  sometimes  occasion  simple  meningitis. 


JAUNDICE;    BILIOUSNESS 

Is  it  unusual  for  a  child  of  five  to  have  jaundice? 
What  can  be  done  for  biliousness  ? 

Jaundice  is  one  of  the  rarer  conditions  in  young  children. 

If  by  '^biliousness"  is  meant  an  attack  of  gastro-intestinal 
catarrh,  the  treatment  is  not  one  for  domestic  practice.  If 
that  word  is  intended  to  mean  the  tendency  shown  by  some 


298  THE  CENTURY  BOOK  FOR  MOTHERS 

persons,  young  and  old,  to  such  attacks,  the  prevention  must 
lie  in  a  careful  dietary,  avoidance  of  indigestible  articles  of 
food,  as  well  as  of  excess  in  the  use  of  proteids  and  fats,  regu- 
larity of  the  bowels,  and  good  general  hygiene. 


HYDROCEPHALUS,  OR  WATER   ON   THE  BRAIN 

How  can  one  recognize  early  enough  the  distressing  disease 
known  as  "water  on  the  brain"?  What  is  the  proper  treat- 
ment for  it? 

The  name  ''water  on  the  brain"  is  a  popular  one,  and  has 
been  applied  to  more  than  one  form  of  inflammation  of  the 
brain  membranes  (meningitis),  with  collection  of  liquid.  We 
do  not  know  which  you  have  in  mind  in  asking  your  ques- 
tion. The  chronic  form,  called  hydrocephalus,  is  most  read- 
ily recognized  by  the  increased  size  of  the  head,  which  is  a 
pretty  constant  symptom.  This  often  reaches  such  a  degree 
that  the  child  cannot  hold  up  its  head.  If  the  enlargement 
begins  early  and  advances  rapidly,  the  functions  of  the  brain 
are  interfered  with,  the  acuteness  of  the  intelligence  and  of 
the  special  senses  being  impaired,  with  other  nervous  mani- 
festations. In  slowly  progressing  cases  this  is  often  not  so; 
but  in  any  case  death  usually  occurs  in  the  early  years. 

There  is  another  and  more  frequent  disease  called  ''water 
on  the  brain,"  or  acute  hydrocephalus,  which  is  the  tubercu- 
lar form  of  meningitis.  The  early  symptoms  of  this  disease 
are  not  pronounced  nor  certain,  and  are  more  often  recol- 
lected after  the  disease  is  recognized  than  noticed  at  the  time. 
These  beginnings  may  be  mistaken  for  some  other  disease,  or 
the  reverse.  But  after  a  time  distinct  brain  symptoms  ap- 
pear, such  as  stupor,  convulsions,  dread  of  light,  screaming, 
etc.,  one  alternating  with  another,  with  some  fever.  It  is 
not  worth  while  to  detail  the  painful  sequence  of  symptoms 
that  conduct  to  the  fatal  end,  which  as  a  rule  comes  in  from 
one  to  four  weeks. 

As  to  the  treatment,  nothing  need  be  said.     Many  years 


COMMON  DISEASES  299 

ago  the  writer  heard  a  distinguished  medical  lecturer  say, 
'^The  only  reason  we  have  for  treatment  is  the  hope  that  we 
have  made  an  error  in  diagnosis. ' '  If  recovery  from  a  genu- 
ine attack  of  the  disease  ever  occurs,  it  is  so  rare  that  the 
most  experienced  observers  express  their  doubts  of  its  exist- 
ence, and  many  frankly  say  that  they  have  never  seen  it. 

THE  CHARACTERISTICS   OF   HERNIA 

My  little  boy,  now  twenty-one  months  old,  has  a  protrusion  of 
the  navel  about  one  quarter  of  an  inch,  or  the  size  of  a  large 
bean.  It  has  been  so  since  he  was  three  months  old.  I  put  a 
compress  on  it  while  he  wore  bands,  but  it  did  no  good. 
Finally,  I  discarded  both  band  and  compress,  and  it  grew  no 
worse;  neither  does  it  improve.     It  was  not  caused  by  crying. 

What  treatment  would  you  advise,  if  any?  I  have  read  that 
rupture  of  the  navel  should  be  cured  before  the  age  of  three 
years,  or  the  cure  would  be  difficult. 

I  do  not  consider  my  little  boy's  rupture  very  bad,  but  it  ought 
not  to  exist  at  all.  Do  you  think  there  is  a  probability  that 
it  will  grow  worse  if  not  attended  to? 

First  examine  the  protrusion  to  see  if  it  be  really  a  rupture, 
and  not  one  of  the  naturally  protruding  navels.  This  you 
can  probably  determine  (if  not,  your  physician  can)  by  ob- 
serving whether  the  protrusion  contains  anything  that  can  be 
pushed  back  within  the  body.  This  movable  part,  if  it  exists, 
constitutes  the  real  hernia.  If  it  is  a  real  hernia  it  ought  to 
be  attended  to. 

THE  CAUSES   OF   RUPTURE 

What  causes  rupture?  People  tell  me  carelessness  of  the  nurse. 
What  form  of  carelessness? 

Rupture  is  caused  by  the  combination  of  some  effort  of  strain- 
ing acting  upon  one  of  the  naturally  weak  points  of  the  abdo- 
men. The  navel  and  the  groins  are  in  infancy  the  usual 
points.    We  believe  that  in  infancy  it  is  commonly  due  to  the 


300  THE  CENTURY  BOOK  FOR  MOTHERS 

fact  that  the  children  who  are  ruptured  are  less  strongly 
built  at  these  places  of  danger  than  are  other  children.  We 
know  of  no  form  of  ' '  carelessness  of  the  nurse ' '  likely  to  cause 
rupture.  The  binders  often  put  on  by  nurses  through  mis- 
taken care  we  think  more  likely  to  do  harm  than  good.  The 
blame  is  put  upon  the  nurse  because  the  ordinary  person  can- 
not conceive  that  his  or  her  baby  could  have  a  weak  spot. 


TREATMENT  OF   HERNIA 

Is  hernia  ever  cured  in  a  boy  three  years  old  by  wearing  a  truss, 
and,  if  so,  what  kind  of  a  truss  would  you  advise?  Ought  a 
child  so  afflicted  to  be  allowed  to  romp  and  play  as  other  chil- 
dren do? 

Hernia  is  sometimes  cured  by  a  truss.  The  kind  must  be  de- 
termined by  the  needs  of  the  case,  and  the  treatment  neces- 
sarily demands  a  long  time.  The  child  should  be  restrained 
in  its  games  only  so  far  as  regards  those  involving  special 
strains.  For  it  seems  to  us  that  to  make  a  self-conscious  in- 
valid of  a  little  child  is  worse  than  an  uncured  hernia.  A 
gameless  childhood  is  dreary  indeed,  but  we  ought  to  add 
something  more  than  your  inquiries  strictly  call  for— namely, 
that  at  the  present  time  the  truss  is  not  our  only  recourse. 
If  it  does  not  do  its  work  satisfactorily,  a  radical  operation 
can  be  performed  which  in  good  surgical  hands  is  safe  and 
in  a  great  proportion  of  cases  successful  in  making  a  real 
cure. 

TREATMENT  OF  A   PROTRUDING  NAVEL 

Will  you  tell  me  if  a  navel  extending  about  three  quarters  of  an 
inch  needs  special  attention?  What  is  the  effect  of  the  rup- 
ture on  the  child,  and  what,  if  anything,  must  be  done  to 
cure  it  ?  It  does  not  seem  to  trouble  him,  and  the  family  physi- 
cian says  it  needs  only  a  tight  flannel  band,  but  I  object  to 
tight  bands  and  use  the  knitted  ones.  If  an  appliance  is 
needed,  is  a  home-made  one  of  value? 


COMMON  DISEASES  301 

Ordinarily,  a  navel  which  protrudes  three  quarters  of  an  inch 
in  a  child  three  months  old  does  need  attention.  There  are 
occasional  exceptions.  The  effects  of  a  rupture  if  neglected 
are  usually  not  great  at  first,  some  pains  and  discomforts  per- 
haps being  all ;  but  whoever  has  a  hernia  carries  a  threat  of  a 
sudden  and  fatal  peritonitis  from  the  possible  strangulation 
of  the  hernia.  Besides,  even  if  no  dangerous  results  happen,  a 
hernia  is  always  an  added  burden  to  carry  through  life.  Your 
physician  advises  the  flannel  band  for  a  particular  reason; 
you  have  no  right  to  set  up  your  preferences  against  his 
judgment,  at  the  risk  of  grave  results  to  the  child.  If  you 
doubt  his  judgment,  or  if  his  treatment  is  not  efficient,  try 
some  other  physician,  but  do  not  neglect  the  navel  unless  you 
are  assured  by  the  present  physician,  or  some  other  good  one, 
that  there  is  no  hernia. 


FALLING  OF  THE  BOWEL 

Can  you  advise  me  what  to  do  for  falling  of  the  bowel  in  a 
young  child?    What  can  be  done  to  prevent  it? 

The  falling  usually  occurs  at  stool.  To  prevent  it,  keep  the 
bowels  free,  so  that  straining  is  unnecessary ;  also,  if  the  ten- 
dency to  fall  is  marked,  it  may  be  better  not  to  set  the  child 
upon  the  chair,  but  to  let  it  have  its  evacuations  in  its  nap- 
kins in  a  recumbent  posture.  Or,  if  the  chair  is  used,  do  not 
let  it  sit  a  long  time.  As  soon  as  the  evacuation  has  occurred 
wipe  and  wash  the  parts,  and  then,  with  the  fingers  anointed 
with  vaseline  or  some  other  unguent,  press  the  bowel  upward, 
the  central  part  first,  as  that  probably  came  out  last.  After 
the  last  part  goes  back,  follow  it  up  an  inch  or  more  with  the 
finger,  to  make  sure  that  all  is  in  place.  Dry  the  parts,  and 
if  the  tendency  to  come  down  is  marked  put  a  pad  of  ab- 
sorbent cotton  or  gauze  against  the  seat,  and  retain  it  with 
a  napkin  or  bandage.  This  is  for  the  emergency.  The  cure 
depends  upon  the  cause  or  attendant  conditions,  and  for  it 
a  physician's  advice  is  needed. 


X 

HARMFUL  HABITS 

THUMB-SUCKING 

In  your  personal  observation,  have  you  ever  seen  children  whose 
teeth  projected,  or  whose  upper  jaws  were  V-shaped,  because 
of  having  sucked  their  thumbs? 

We  have  often  seen  the  V-shaped  jaw  in  children  who  were 
thumb-suckers.  It  is  reasonable  to  suppose  that  the  habit 
was  the  cause,  although  it  would  be  impossible  to  prove  that 
the  jaw  might  not  have  had  this  shape  had  the  child  not 
sucked  its  thumb,  because  such  shaped  jaws  belong  to  some 
families,  and  no  one  can  recollect  whether  or  not  the  elders 
were  also  thumb-suckers.  Further,  we  have  seen  other  and 
more  complicated  distortions  of  the  upper  jaw,  and  even  of 
the  nose,  probably  caused  by  the  pressure  of  thumb-sucking, 
which  it  required  much  trouble  on  the  part  of  the  dentist, 
and  expense  on  the  part  of  the  parents,  to  correct.  Those 
w^ho  have  given  most  study  to  the  matter  (scientific  dentists) 
agree  in  considering  thumb-sucking  a  potent,  if  not  the  main, 
cause  of  the  V-shaped  jaw. 

OBJECTIONS   TO   "BABY'S   COMFORTER" 

Will  you  be  kind  enough  to  enumerate  the  reasons  why  a  "baby's 
comforter"  should  not  be  used?  I  have  never  used  the  article 
in  question,  but  I  really  do  not  know  why  I  should  not,  for  I 
know  no  argument  against  it,  and  while  I  should  not  like  to 
see  it  in  my  baby's  mouth  constantly,  it  probably  would  stop  a 
disagreeable  noise  when  she  is  waiting  for  her  milk  to  warm. 

302 


HARMFUL  HABITS  303 

To  enumerate  the  reasons— that  is  to  say,  many  of  them— 
would  be  tedious.  The  function  of  the  medical  adviser  is 
rather  to  give  his  opinion,  based  on  his  experience,  than  to 
detail  the  experience  which  formed  the  opinion.  Still,  we 
can  give  you  a  few  of  our  reasons  in  short  space.  We  be- 
lieve that  the  habit  of  chewing  or  sucking,  except  upon  food 
to  be  swallowed,  is  undesirable,  on  physiological  grounds 
as  well  as  for  other  reasons.  The  tobacco  and  gum  habits 
are  properly  alluded  to  in  this  connection,  because  we  think 
that  this  habit  of  chewing  things  other  than  food  is  an  ex- 
pression of  nervousness,  and  that  the  "comforter"  habit 
(and  thumb-sucking  as  well)  is  the  direct  progenitor  of  those 
more  objectionable  habits,  through  the  establishment  of  the 
desire  for  something  in  the  mouth.  The  method  of  the  ex- 
pression of  this  desire  is  very  various.  Witness,  for  instance, 
the  contemporary  caricatures  of  Lord  Palmerston,  whose 
figure  would  hardly  have  been  recognized  without  the  straw 
in  his  mouth.  Further,  unless  we  are  mistaken,  this  desire 
to  suck  or  chew,  when  it  is  not  an  expression  of  pure  ner- 
vousness, does  express  some  positive  discomfort,  ordinarily  in 
the  digestive  tract— mouth,  pharynx,  stomach,  or  bowels— 
and  that  it  would  better  be  cured  than  masked. 


HOLDING   THE   BREATH 

My  little  daughter,  now  past  fourteen  months,  has  somehow  ac- 
quired the  habit  of  holding  her  breath.  This  is  particularly 
trying,  and  sometimes  looks  alarming,  when  she  does  it  at 
the  table,  with  some  food  in  her  mouth.  Could  you  tell  me 
what  to  do  in  such  cases?  What  is  the  best  way  of  treating 
this  habit,  which,  I  suppose,  is  the  result  of  temper?  Some- 
times a  trifling  refusal  will  bring  it  on,  generally  at  times 
when  for  some  reason  she  is  out  of  sorts.  Should  I  humor 
her,  rather  than  run  the  risk  of  bringing  on  this  distressing 
exhibition,  or  should  she  be  made  to  understand  every  time 
that  she  cannot  have  her  own  way?  Is  the  habit  really  dan- 
gerous, and,  in  case  of  a  particularly  severe  show  of  temper, 
would  a  smart  slap  bring  the  breath  back? 


304  THE  CENTURY  BOOK  FOR  MOTHERS 

The  holding  of  the  breath  in  itself  is  not  dangerous,  but  is  a 
trick  that  some  children  acquire.  Of  course,  her  Avhims 
should  not  be  humored,  assuming  her  to  be  in  good  health. 
She  can  be  made  to  breathe  easily  enough  by  any  of  the 
manoeuvres  that  are  used  to  start  respiration  when  it  has  been 
accidentally  stopped  (or  has  not  been  established,  as  is  often 
the  case  with  a  new-born  infant),  such  as  the  ''spank,"  a 
dash  of  cold  water  in  the  face,  or  violent  blowing  in  the  face. 
AVhether  it  is  worth  while  to  resort  to  such  measures,  which, 
while  entirely  physiological,  have  the  appearance  of  a  pun- 
ishment, must  depend  upon  individual  cases.  Most  children, 
if  they  find  that  the  mother  cannot  be  made  to  yield  to  their 
desires  and  cannot  be  frightened  by  this  holding  of  the 
breath,  promptly  abandon  the  habit,  while  it  is  certainly  pro- 
longed by  indulgence. 

NAIL-BITING   AND   ITS   CURE 

In  despair,  I  write  you  to  learu,  if  possible,  how  to  prevent  our 
boy  of  ten  years  from  biting  his  nails.  Although  a  very 
bright  boy  (of  nervous  habit),  he  has  his  hands  almost  con- 
stantly in  his  mouth,  which,  to  our  mortification,  gives  him 
the  look  of  an  idiotic  child.  We  have  tried  gloves,  with  no 
success ;  latterly  some  one  watches  him  to  keep  his  hands  down 
from  his  face,  and  the  child  is  constantly  hearing,  "Hands 
down!" 

If  you  will  suggest  a  remedy  for  this  disease,  weakness  of  the 
will — which  is  it? — you  will  have  my  warmest  thanks. 

The  habit  of  nail-biting  is  mortifying  and  to  a  certain  extent 
disfiguring,  but  it  should  not  be  taken  too  seriously— that  is 
to  say,  it  should  not  be  worried  over  as  a  real  disease.  We 
believe  that  it  should,  in  a  general  way,  be  classed  with 
habit-spasms,  because  it  is,  or  was  originally,  an  expression 
of  a  discomfort,  usually  nervous,  and  is  continued  from  habit 
and  absent-mindedness.  "Weakness  of  will  we  do  not  think  it 
usually  is,  unless  any  neglect  of  self-control  or  any  indolent 
self-indulgence  is  to  be  so  called,  because  we  have  known  some 


HARMFUL  HABITS  305 

persons,  who  carried  nail-biting  to  an  extreme,  who  were 
by  no  means  lacking  in  will-power  if  anything  awakened  it. 

If  we  are  right  in  this  view  of  the  nature  of  the  habit,  the 
cure  would  consist  in  first  doing  all  practicable  to  strengthen 
the  nervous  system  and  make  it  comfortable  and  quiet,  and 
then  the  local  preventive  measures  will  take  better  effect. 

The  local  measures  generally  adopted  are  the  use  of  gloves, 
which  you  have  already  tried,  and  the  application  to  the  fin- 
ger-ends of  some  very  strong-tasting  substance,  the  taste  of 
which  recalls  the  child  from  his  abstraction,  which  is  the  root 
of  the  habit.  The  gloves  (or  bags,  which  are  often  used)  will 
prevent  nail-biting,  but  not  the  sucking  of  the  fingers  or 
thumbs.  The  substances  used  on  account  of  taste  are  various, 
aloes  tincture  being  the  commonest.  But  we  believe  that 
general  hygienic  improvement  is  quite  as  important  as  the 
local  measures. 

THE   CHEWING-GUM   HABIT   IN    CHILDREN 

Is  it  true  that  it  benefits  children  to  chew  gum,  and  that  it 
helps  them  to  digest  their  food?  I  send  you  inclosed  an  ex- 
tract from  an  article  in  a  leading  religious  paper  claiming 
that  it  is  good  to  promote  the  flow  of  saliva  by  chewing  gum, 
and  that  it  prevents  children  from  becoming  too  hungry  be- 
tween meals. 

These  discussions  as  to  the  harmfulness  or  benefits  of  chew- 
ing gum  come  up  in  the  newspapers  from  time  to  time.  It 
is  usually  believed  that  the  chewing  of  gum  is  distinctly  in- 
jurious by  fatiguing  the  salivary  glands;  but  now  and  then 
a  dissenting  voice  is  heard  urging  that  the  increased  flow  of 
saliva  is  useful,  both  before  meals  and  between  meals,  in  aid- 
ing the  progress  of  digestion.  That  the  flow  of  saliva  is  es- 
sential to  digestion,  and  most  of  all  for  the  digestion  of  starchy 
foods,  every  one  knows,  but,  after  all,  we  feel  bound  to  give 
our  vote  against  the  chewing-gum  habit.  If,  in  chewing, 
the  saliva  were  always  swallowed,  and  if,  being  swallowed, 
it  could  be  placed  just  ''where  it  would  do  the  most  good," 

20 


306       THE  CENTURY  BOOK  FOR  MOTHERS 

and  if,  lastly,  it  were  necessary  for  any  one  to  take  starchy 
food  unchewed  into  the  stomach,  the  argument  for  chewing 
gum  or  some  other  similar  substance  would  be  strong.  But 
for  the  saliva  to  do  the  most  good  it  should  be  thoroughly 
mixed  with  the  bolus  of  food  in  the  act  of  chewing. 

Far  better  than  to  chew  gum  is  it  to  thoroughly  chew  the 
food  itself.  If  we  are  right  in  thinking  the  chewing-gum 
practice  an  unwholesome  one  for  adults,  it  is  doubly  so  for 
young  children,  who  are  to  a  certain  extent  irresponsible, 
and  who  easily  contract  the  habit  of  bolting  food  and  of 
chewing  everything  else.  Our  advice  would  be  to  prevent  as 
far  as  possible  the  chewing-gum  habit  and  to  encourage  pro- 
longed chewing  at  the  table ;  and  this  is  especially  necessary 
when,  as  is  usual  in  childhood,  the  diet  is  largely  made  up 
of  cereals.  Many  of  our  attempts  to  render,  by  cooking, 
food  easy  of  consumption  may,  through  carelessness,  result 
in  rendering  it  difficult  of  digestion.  For  instance,  it  is 
very  desirable  that  potatoes  should  be  well  chewed;  to  make 
this  easy  we  mash  them ;  as  a  result,  they  are  frequently  not 
chewed  at  all,  but  bolted.  Similarly,  we  take  bread,  which 
should  be  chewed,  and  which  usually  must  be,  to  a  certain 
degree,  before  swallowing,  and  make  of  it  milk-toast,  which 
is  taken  into  the  stomach  almost  untouched  by  the  necessary 
saliva.  If  children  come  to  the  table  too  hungry,  give  them 
first  a  drink  of  milk  or  a  little  broth,  and  keep  the  food  that 
should  be  chewed  until  hunger  is  sufficiently  appeased  to 
allow  them  to  take  solid  food. 

LIP-SUCKING 

Is  lip-sucking  common  in  young  children?     Is  there  any  way  of 
curing  it? 

It  is  not  very  common.  "We  have  noticed  it  in  those  children 
who  have  a  strong  tendency  to  some  such  habit,  and  have  been 
prevented  from  its  first  expression— say,  thumb-sucking. 
There  is  no  direct  method  of  cure  until  the  child  is  old 
enough  to  be  reasoned  with. 


XI 

PHASES  OF  DEVELOPMENT 

THE   INFANT'S   NORMAL  WEIGHT 

How  much  ought  the  normal  child  to  gain  in  one  week?    What 
is  an  average  or  fair  weight  for  a  child  of  four  months? 

Growi:h  varies  greatly  according  to  age.  During  the  first 
week  there  is  usually  a  slight  loss,  which  loss  is  really  made 
in  the  first  three  days.  After  this  is  overcome  the  gain  is 
continual,  but  not  uniform.  It  varies  first  of  all  with  differ- 
ent children,  depending  somewhat,  but  not  entirely,  upon 
the  original  size  and  strength  of  the  child.  A  quarter  of  a 
pound  per  week  is  a  fair  gain  for  the  first  month  or  two,  but 
the  gain  often  reaches  half  a  pound  weekly  for  this  period. 
By  the  age  of  four  months  it  is  slackening,  being  usually 
not  much  above  a  quarter  of  a  pound  per  week.  The  weight 
at  that  age  will  be  on  an  average  about  twelve  pounds,  some- 
times fourteen  or  more,  but  the  weight  at  four  months,  owing 
to  the  progressive  retardation  of  growth,  is  on  the  average 
more  than  half  what  it  will  be  at  one  year.  Thus  a  child  who 
weighs  fourteen  pounds  at  four  months  cannot  be  expected 
to  weigh  above  twenty-five  pounds  at  twelve  months,  if  so 
much ;  and  the  weight  at  one  year  will  not  on  the  average  be 
again  doubled  before  the  eighth  year  is  reached.  It  is  usual 
to  consider  that  the  birth  weight  shall  be  doubled  at  five 
months  and  trebled  at  one  year,  but  this  is  not  true  if  the 
birth  weight  is  exceptionally  large. 

307 


308  THE  CENTURY  BOOK  FOR  MOTHERS 

MEASUREMENTS   AND   WEIGHTS   OF   BOYS   AND 
GIRLS  AT   VARIOUS   AGES 

Will  you  please  give  the  average  height  and  weight  and  chest 
measures  of  a  two-year-old,  also  of  a  three-year-old  child?  Is 
there  found  to  be  a  difference  between  an  average  boy  and  an 
average  girl  of  these  ages  in  regard  to  size  and  weight? 

While  we  have  a  good  many  figures  regarding  the  first  year, 
and  abundance  concerning  the  school  age— six  years  and  up- 
ward—we have  few  regarding  the  interval  from  one  to  six 
years.  Dr.  Holt  has  recorded  the  results  of  weighing  and 
measuring  three  hundred  and  seventy-two  children  from  the 
second  to  the  fifth  year.     These  results  are  £is  follows : 

Two  Years.— Weight:  boys,  26.5  pounds;  girls,  25.5. 
Height,  32.5  inches  for  both  sexes.  Chest,  middle  of  inspi- 
ration, boys,  19  inches;  girls,  18.5. 

Three  Years.— Weight :  boys,  31.2  pounds;  girls,  30. 
Height,  35  inches  for  both  sexes.  Chest,  boys,  20.1  inches; 
girls,  19.8.  Boys  keep  ahead  until  about  twelve  years,  then 
fall  behind  until  about  fifteen  years,  when  the  adult  prepon- 
derance of  the  male  begins. 

It  is  to  be  borne  in  mind  that  for  certainty  of  deduction 
the  number  of  cases  must  be  very  large  (thousands)  ;  more- 
over, the  race,  the  social  condition,  and  the  locality  must  be 
noted.  As  regards  our  own  population,  the  investigations  of 
Bowditch,  W.  T.  Porter,  and  Boaz  are  particularly  interest- 
ing, bringing  out  differences  according  to  native  or  foreign 
parentage,  the  well-to-do  and  the  poorer  classes,  and  between 
different  cities,  east  and  west,  and  many  other  details. 


WHEN   CHILDREN   FIRST   BEGIN   TO   SEE 

Is  it  true  that  a  baby  cannot  see  anything  when  it  is  born,  and 
not  for  days  afterward?  When  does  it  learn  to  distinguish 
colors?  Do  not  a  child's  eyes  express  very  early  its  pleasure 
or  pain? 


PHASES  OF  DEVELOPMENT  309 

Vision,  according  to  Preyer,  is  not  in  the  child's  power  in 
his  first  weeks.  He  begins  by  distinguishing  masses  of  light 
and  shade;  a  small  bright  spot,  when  very  bright,  as  a  can- 
dle-flame, he  can  separate,  after  a  few  days,  from  the  sur- 
rounding gloom.  Of  colors  he  learns  first  to  know  red  and 
yellow;  the  blue  end  of  the  spectrum  gives  him  much  more 
trouble,  possibly  because  blue  is  more  absorbed  than  the  other 
colors  by  the  blood-vessels  of  the  retina.  The  involuntary 
closing  of  the  lid  when  an  object  approaches  the  eye  is  wholly 
wanting  at  first ;  it  is  developed  by  the  unpleasant  feeling 
of  a  sudden  change  in  the  field  of  vision  (not  as  a  means  of 
warding  off  a  recognized  danger),  and  its  occurrence  in  the 
second  and  third  months  is  a  sign  of  completed  power  of  see- 
ing. Wide-open  eyes  are  a  sign  of  pleasure ;  discomfort  and 
pain  are  accompanied  by  a  partial  closing  of  the  lids.  For 
the  first  three  weeks  the  child's  evident  look  of  pleasure  on 
being  put  into  the  warm  bath  is  due  to  the  open  eyes  shining 
from  an  increased  secretion  of  the  tear-glands. 

DEVELOPMENT   OF  THE   SALIVA  AND   TEAR-GLANDS 

According  to  several  well-known  authorities,  a  baby  does  not 
secrete  saliva  before  four  months.  My  baby  has  drooled  con- 
stantly since  three  weeks,  and  is  now  two  months  old;  what 
does  this  signify? 

I  also  read  that  it  is  impossible  for  a  very  young  baby  to  shed 
tears.  Mine  has  fairly  rained  tears  since  the  first  week.  Is 
this  an  unhealthy  symptom? 

All  statements  regarding  the  time  at  which  this  or  that  func- 
tion appears  are  based  upon  averages  of  observations.  One 
does  not,  for  instance,  expect  teeth  to  appear  before  the  sev- 
enth month,  yet  a  physician  of  experience  will  recall  in- 
stances of  much  earlier  eruption  of  the  incisors,  and  may 
even  have  seen  them  at  birth.  There  is  nothing  to  be  consid- 
ered in  the  case  of  your  little  one  except  to  note  that  the 
saliva  and  tear-glands  developed  earlier  than  the  average. 
This  is  not  a  harmful  exhibition  of  precocity. 


310  THE  CENTURY  BOOK  FOR  MOTHERS 


THE  DEVELOPMENT  OF  SPEECH 

Why  do  some  children  begin  to  speak  so  much  later  than  others? 

Is  this  necessarily  an  indication  of  some  physical  weakness? 

All  my  children  began  to  talk  late,  although  otherwise  normal 

in  their  development. 
What  do  you  consider  the  average  age  when  children  ought  to 

begin  to  talk? 

We  cannot  answer  the  question  in  any  but  a  general  way. 
The  power  of  speech  being  a  mental  gift,  it  is  developed 
very  differently  both  as  to  degree  and  time.  Fluency  of  lan- 
guage is  no  gauge  of  mental  power  in  general.  The  most 
eloquent  lawyer  is  not  necessarily  the  ablest  one.  The  pe- 
culiarities of  development  in  time  also  vary.  We  recall  many 
striking  instances.  Entire  families  of  good  mental  abilities 
have  shown  very  tardy  development  of  speech.  One  mem- 
ber (we  have  in  mind  an  actual  instance)  was  practically 
speechless  until  about  four  years  of  age,  when  speech  began 
suddenly  and  about  as  fluent  as  the  average  at  that  age. 
Other  members  had  such  broken  and  lisping  forms  of  speech 
as  to  be  unintelligible  to  those  who  were  not  in  daily  contact 
with  them,  but  all  after  a  while  talked  as  well  as  this  child. 
Instances  might  be  multiplied  of  these  peculiarities  and  va- 
garies. We  should  have  no  anxiety  about  a  child  who  was 
not  deaf  and  was  apparently  intelligent,  if  speech  came  late. 
The  average  age  would  depend  upon  what  is  meant  by  talk- 
ing. Children  say  a  few  words  ordinarily  well  within  the 
first  year— ^' Mama,"  etc. ;  after  that  all  the  variations  above 
described  appear,  very  great  contrast  being  noticed  in  chil- 
dren of  the  same  age  of  kindred  blood  and  similar  sur- 
roundings. 

IMPERFECT  NUTRITION   AND    ITS  CAUSES 

I  wish  to  ask  advice  about  my  little  boy,  who  was  five  years  old 
lately.  He  is  of  very  good  height  for  his  age,  but  thin,  his 
ribs  and  backbone  showing  plainly.     He  is  quite  irritable  at 


PHASES  OF  DEVELOPMENT  311 

times,  and  is  altogether  a  very  nervous  child.  Lately  he  wakes 
up  in  the  night  and  stays  awake  sometimes  an  hour.  He 
often  wets  the  bed.  His  digestion  and  assimilation  have  al- 
ways been  rather  poor. 
What  can  I  do  for  him?  Would  you  recommend  cod-liver  oil, 
and  can  you  give  me  some  hints  in  regard  to  his  diet? 

It  is  quite  clear  that  the  child's  nutrition  is  imperfect,  and  the 
few  symptoms  given  are  expressions  of  this  fact.  It  would 
be  helpful  if  you  knew  what  causes  have  led  to  this  condition. 
You  will  find  it  profitable  to  inquire  into  the  heredity.  Many 
people  never  think  of  this  as  regards  their  own  families. 
Thus,  consider :  Is,  or  was,  the  thinness  and  under-nutrition 
a  characteristic  of  the  child's  ancestors,  either  in  adult  life 
or  in  childhood?  Did  they  outgrow  it,  etc.?  Also,  has 
the  child's  condition  been  caused  or  aggravated  by  known 
illnesses  or  by  errors  in  feeding,  etc.?  All  these  things 
are  necessary  to  a  proper  understanding  of  what  is  to  be  cor- 
rected. Next  is  to  be  considered — and  here  medical  advice 
is  useful— the  question.  Is  the  child  not  definitely  ill  now? 
AVhen  these  things  are  known,  treatment  will  be  intelligent. 
The  diet  must  be  governed  by  the  same  things,  especially  by 
the  present  condition  of  the  digestive  organs.  As  to  cod-liver 
oil,  we  can  only  say  that  it  is  very  generally  useful  if  the 
stomach  bears  it. 

DROOPING  SHOULDERS 

Would  you  advise  me  to  put  braces  on  my  boy  of  four,  who  has 
drooping  shoulders? 

Unless  a  child  is  too  feeble  to  hold  himself  up,  we  do  not 
think  any  support  advisable.  If  a  child  stoops  because  of 
near-sight,  as  is  sometimes  the  case,  he  should  have  glasses. 
The  ordinary  kind  of  stoop  in  childhood  is  best  cured  by 
plenty  of  active  play,  not  too  violent,  but  enough  to  develop 
the  muscles  of  the  shoulders,  back,  chest,  and,  in  fact,  of  the 
whole  trunk. 


312  THE  CENTURY  BOOK  FOR  MOTHERS 

LEFT-HANDEDNESS 

Our  little  girl,  aged  two  years  and  four  months,  is  inclined  to 
be  left-handed.  At  the  table  she  makes  use  of  the  left  hand 
entirely,  and  in  cutting  with  a  small  scissors  she  uses  the 
left  hand.  What  can  we  do  to  break  her  of  the  habit?  I 
have  noticed  that  our  baby,  aged  seven  months,  also  shows 
signs  of  preferring  the  left  hand  for  grasping  and  holding 
things  to  her  mouth.  We  are  a  right-handed  family,  but  I 
have  wondered  if  w^e  have  not  made  the  children  left-handed 
by  always  offering  them  things  with  the  right  hand.  Natu- 
rally, they  take  them  with  the  left.  Is  there  anything  in  this 
theory,  or  do  children  usually  use  the  left  hand  first,  as  they 
first  see  things  "upside  down"? 

Left-handedness  is  not  such  a  misfortune  as  some  people  seem 
to  think.  It  is  such  chiefly  in  that  it  makes  the  left-handed 
person  noticeable.  It  is  not  an  impairment  of  power  or  suc- 
cess, except  in  the  use  of  tools  or  implements  constructed  ex- 
pressly for  use  in  the  right  hand,  like  the  scissors,  for  in- 
stance. Most  left-handed  persons  can  be  taught  to  use  the 
right  hand  for  most  acts,  but  when  force  is  required  the  left 
hand  is  pretty  certain  to  be  called  upon.  This  being  the 
case,  it  is  well  not  to  neglect  the  left  hand  entirely.  Since 
two  dexterous  hands  (two  right  hands,  in  other  words)  are  a 
great  convenience,  our  notion  is  that  she  should  be  taught  to 
use  the  right  hand  for  all  things  where  the  use  of  the  left 
would  excite  comment,  such  as  the  pen,  the  knife  at  table,  etc. 
The  right-handed  habit  of  the  civilized  races  seems  to  have 
been  in  considerable  degree  acquired.  Hoav,  no  one  knows. 
In  infancy  it  is  often  wanting  in  those  not  left-handed,  and 
has  to  be  taught.  And  to  our  mind  it  is  often  taught  to  a 
foolish  and  even  harmful  degree— that  is,  to  such  an  extent 
that  the  left  hand  is  nearly  useless,  except  for  simple 
grasping. 


XII 
WEANING 

SYSTEMATIC  WEANING 

I  apply  to  you  for  advice  in  regard  to  systematically  weaning 
my  baby.  She  is  now  ten  months  old,  well  and  hearty  and 
plump,  though  having  as  yet  no  teeth.  She  never  has  been 
fed  at  all,  nothing  except  water  ever  being  put  into  her  mouth. 
A  chicken-bone  or  a  crust  of  bread  she  often  has  to  play  with, 
but  that  can  hardly  be  called  food.  There  is  still  an  abundant 
supply  at  "Nature's  fount,"  but  I  would  prefer  to  wean  her 
as  soon  as  settled  cool  weather  comes.  What  should  she  have 
to  begin  with,  and  in  what  quantities? 

Although  there  are  exceptions,  a  child  can  usually  be  suc- 
cessfully weaned  with  no  great  difficulty  if  the  mother  sim- 
ply persists  in  her  purpose.  The  infant,  of  course,  does  not 
enjoy  the  change,  and  the  greatest  obstacle  to  the  weaning 
is  the  mother's  natural  desire  to  yield  to  the  little  one's 
importunities.  As  a  contrast,  it  is  interesting  to  study  the 
skill  with  which  the  domestic  animals  wean  their  young  at 
the  proper  time.  In  the  weaning  the  welfare  of  the  child  is, 
of  course,  the  prime  consideration,  but  the  mother's  com- 
fort should  not  be  overlooked.  For  the  latter  reason,  if  the 
supply  of  milk  be  still  large,  the  abrupt  cessation  of  nursing 
may  be  undesirable,  owing  to  the  distressing  filling  of  the 
breasts. 

It  is  assumed  that  the  weather  is  settled  and  that  the 
child  is  suffering  from  no  ailment  of  moment.  It  will  much 
simplify  matters  if  the  mother  has  a  trustworthy  assistant 

313 


314       THE  CENTURY  BOOK  FOR  MOTHERS 

who  at  first  can  attend  to  the  feeding,  as  the  child  will  not 
then  be  constantly  begging  for  the  breast,  and,  if  hungry, 
will  probably  take  the  food  prepared  for  it.  The  mother 
should  keep  out  of  sight,  and,  if  possible,  out  of  hearing. 
The  food  should  be  given  at  the  usual  hours  for  nursing,  and 
the  quantity  should  be  as  nearly  as  possible  the  same  as  that 
taken  from  the  breast.  The  amount  taken  from  the  breast 
at  a  nursing  is  determined  by  careful  weighing  of  the  child 
just  before  and  just  after  a  suckling.  The  weight  gained 
in  ounces  represents  practically  the  same  number  of  fluid 
ounces  of  breast  milk  taken.  If  the  amount  is  not  known, 
the  bottle  may  contain  at  first  about  a  gill,  and  if  it  should 
prove  to  be  not  enough  more  can  be  prepared  for  the  next 
time.  The  food  should  be  freshly  made  each  time  and  given 
at  blood-heat.  The  particular  kind  of  food  must  depend 
upon  circumstances.  Where  good  cow's  milk  can  be  had 
it  should  be  the  basis  of  all  baby's  food.  As  to  what  should 
be  mixed  with  it,  different  persons  naturally  differ  slightly. 
Our  own  preference  (the  child  being  already  ten  to  twelve 
months  old)  is  for  barley-water  to  dilute  it  and  sugar  of 
milk  to  sweeten  it.  Usually  two  thirds  milk  and  one  third 
barley-water  will  do  to  begin  with.  As  the  child  grows 
older  and  stronger  less  dilution  is  necessary,  and  the  change 
can  be  gradually  made.  If  the  child's  digestion  is  delicate 
the  milk  may  be  peptonized  with  benefit,  and  by  some  of 
the  methods  a  liquid  very  closely  resembling  human  milk 
may  be  obtained.  If,  however,  a  healthy  child  is  old  enough 
to  be  weaned,  this  precaution  is  rarely  necessary.  It  is  of 
course  understood  that  if  a  child  must  be  weaned  early  the 
food  must  differ  to  suit  the  age. 

DROPPING   THE    NIGHT   MEAL 

At  what  age  and  how  can  a  baby  best  be  weaned  nights?     If  he 
wakes  up  and  wants  the  bottle,  should  he  be  allowed  to  cry? 

At  six  months  usually,  by  eight  months  pretty  certainly,  a 
child  can  go  from,  say,  10  p.m.  till  early  morning,  and  would 


WEANING  315 

better  do  so.  There  is  only  one  way  to  accomplish  this. 
Arrange  the  day's  meals  so  that  the  last  comes  at  or  about 
10  P.M.  Then,  if  food  is  cried  for,  give  drink  and  get  the 
child  to  sleep  without  feeding.  If  it  will  not  go  to  sleep, 
wait  till  considerably  after  its  usual  time  before  feeding, 
and  each  night  make  the  hour  later  until  your  set  time  is 
reached.  Usually  two  or  three  nights  at  most  win  the  battle. 
Most  of  the  difficulty  comes  from  the  bad  habit  of  feeding 
a  child  whenever  it  cries,  until  it  comes  to  feel  that  it  cannot 
become  quiet  without  the  breast  or  bottle,  when  overfeeding 
may  be  the  real  cause  of  the  restlessness. 

NURSING   DURING   PREGNANCY 

If  a  mother  is  nursing  her  baby  and  discovers  that  she  is  again 
pregnant,  ought  she  to  wean  the  baby  immediately,  or  would  it 
do  any  harm  to  continue  nursing  him  for  some  time,  if  the 
milk  does  not  appear  to  disagree  with  him,  provided  she  feeds 
him  besides?  If  the  milk  does  not  make  the  baby  sick,  would 
it  injure  the  mother  or  the  coming  child  if  she  continued  nurs- 
ing the  baby?     If  so,  in  what  way? 

It  is  usually  much  better  to  begin  the  weaning  as  soon  as  the 
pregnancy  is  known,  for  the  milk  is  very  much  impaired  in 
value,  and  it  is  the  additional  food,  not  the  breast  milk,  that 
the  baby  really  depends  upon  for  his  nourishment.  It  is  not 
to  be  expected  that  the  milk  will  ''make  the  baby  sick"  in 
the  sense  of  directly  ill,  although  this  sometimes  occurs ;  but 
its  results  are  seen  later  in  his  impaired  state  of  health,  these 
results  being  often  considered  mysterious,  although  they 
should  not  be.  The  effect  on  the  mother  and  other  child  may 
not  be  so  evident,  perhaps  not  demonstrable  at  all  as  regards 
the  child,  but  the  strain  upon  the  mother  is  unwarrantable, 
and  but  few  women  can  remain  undamaged  by  it. 


XIII 
SLEEPING 

THE  HAMMOCK  AS  A  SLEEP-INDUCER 

Do  you  consider  hammocks  injurious  to  babies?  My  baby  is 
nearly  five  months  old,  and  for  four  months  I  have  used  a 
hammock  for  her,  getting  her  to  fall  asleep  in  it.  It  made  her 
sick  once,  when  I  first  got  it.  With  this  exception  I  have  never 
been  able  to  discover  any  bad  effects  from  it;  but  I  have  often 
wondered  if  it  could  be  harmful  in  any  way. 

The  hammock,  if  not  violently  swung,  is  no  more  injurious 
than  the  cradle  or  the  rocking-chair,  presupposing  that  it  is 
a  full-sized  hammock,  which  allows  the  child  to  lie  without 
being  doubled  up.  The  whole  question  whether  any  kind  of 
oscillation  is  worth  while  as  a  means  of  getting  a  child  to 
sleep  we  cannot  enter  upon.  Such  manoeuvres  are  not  neces- 
sary, and,  if  begun,  usually  must  be  continued.  The  child 
is  not  benefited,  the  mother  is  taxed.  Nevertheless,  the  plea- 
sure of  putting  one's  baby  to  sleep  in  the  arms  often,  if  not 
always,  repays  the  mother  for  the  tax  imposed,  at  least  while 
it  is  not  too  heavy.  And  in  view  of  the  generations  of  our 
cradle-rocked  and  chair-tilted  ancestors  we  cannot  say  that 
these  rhythmical  motions  are  usually  injurious. 

PUTTING  A  BABY  TO  SLEEP  WITH  THE  RUBBER  NIPPLE; 
"MAGIC"  EFFECTS  OF   SUGAR-RAGS 

How  shall  I  teach  my  four-weeks-old  girl  to  go  to  sleep  alone  by 
herself?     A  friend  of  mine  accustomed  her  first  baby  to  go  to 

316 


SLEEPING  317 

sleep  with  a  rubber  nipple  in  her  mouth,  which  practice  she 
kept  up  till  she  was  three  years  old.  Does  this  ever  produce 
sore  mouth? 
Although  "sugar-rags"  are  an  abomination  to  me,  I  have  been 
guilty  of  trying  them  after  all  other  means  have  failed,  and 
when  imperative  duties  demanded  my  attention.  The  effect 
has  been  magical,  as,  in  almost  the  time  it  takes  to  tell  it,  she 
would  be  sound  asleep.  When  awake  she  is  as  good  and  quiet 
as  I  can  wish  for. 

A  four-weeks-old  baby  ought  to  sleep  two  thirds  of  the  time, 
if  she  is  well.  Nurse  her  to  sleep,  and  when  her  lips  slip 
from  the  nipple  lay  her  dow^n  carefully  in  the  crib.  Unless 
your  nurse  has  already  accustomed  her  to  rocking  and  ''cod- 
dling" on  the  lap,  you  should  have  no  trouble  in  getting  her 
to  lie  still  by  the  hour,  sleeping  or  w^aking.  Why  give  her 
the  rubber  sham  at  all,  since  she  will  only  suck  in  wind  and 
very  likely  have  colic,  and  will  certainly  form  an  absurd 
habit? 

As  to  the  sugar-rag,  the  saccharine,  farinaceous,  and 
greasy  foods  that  make  up  its  contents  seriously  derange  a 
baby's  stomach.  Colic,  wind,  and  disordered  bowels  follow 
in  the  train  of  the  objectionable  things. 

EXPERIMENTING  WITH   ANODYNES 

Will  you  please  tell  me  what  anodyne  is  best  for  me  to  give  my 
six-months-old  baby  ?  She  is  a  bad  sleeper,  and  I  cannot  stand 
being  awake  so  much  at  night.  I  have  given  her  chamomilla, 
and  once  or  twice  a  drop  of  laudanum.  Is  there  anything 
better  than  these? 

We  advise  you  to  give  no  anodyne  at  all  nor  any  sleep-pro- 
ducing medicine,  unless  it  is  recommended  by  a  physician 
after  a  thoughtful  consideration  of  her  case.  The  proper 
thing  to  do  is  to  seek  to  the  best  of  your  ability,  aided  by 
your  physician  if  necessary,  for  the  cause  of  the  wakefulness, 
and  remove  that  cause  if  possible.  A  cause  exists,  and  can 
usually  be  found. 


318  THE  CENTURY  BOOK  FOR  MOTHERS 


A  NIGHT-LIGHT   IN    THE   NURSERY 

What  is  your  advice  about  burning  a  dim  light  in  the  nursery  at 
night?     Can  it  have  a  bad  effect  on  children's  eyes? 

The  light  will  do  no  harm,  especially  if  it  be  so  shaded  as 
not  to  fall  directly  upon  the  child's  face. 


THE  VALUE  OF  THE   PILLOW   IN   SLEEPING 

Please  inform  me  if  you  think  it  advisable  and  beneficial  to 
have  an  infant  of  ten  months  sleep  without  a  pillow,  or  the 
head  elevated  at  all.  I  have  always  heard  that  a  child  becomes 
more  straight  by  lying  on  its  back  without  the  head  being 
raised. 

It  is  really  of  no  great  importance,  provided  the  pillow  is 
flat  and  thin.  If  a  child  were  to  lie  flat  upon  the  back  it 
would  be  better  to  have  no  pillow.  If  upon  the  side,  as  adults 
sleep,  a  thin  pillow  would  be  better.  In  fact,  the  infant, 
after  it  is  able  to  move,  lies  in  a  very  composite  way,  and 
practically  it  seems  to  us  that  a  slight  lift  to  the  head,  just 
to  save  the  neck  from  twisting,  is  rather  the  more  comfortable. 


THE  MOST  COMFORTABLE  PILLOW 

Please  give  me  some  information  in  reference  to  the  contents 
of  a  pillow  calculated  to  give  the  baby  the  most  comfort.  I 
use  at  present  one  filled  with  best  quality  of  white  horsehair, 
but  find  that  the  same  has  a  tendency  to  fall  in.  The  head 
sinks  into  the  pillow,  so  as  to  obstruct  the  free  and  easy  breath- 
ing, the  nose  being  buried  in  the  pillow.  I  have  heard  of 
using  "bran"  for  filling.     What  do  you  suggest? 

Hair  is  the  best,  but  it  should  be  thin  and  firm,  so  that  it  will 
not  fall  in.  A  little  child 's  pillow  needs  to  be  not  more  than 
two  inches  thick  at  the  most. 


SLEEPING  319 


THE   FIR-PILLOW 

Will  you  please  inform  me  whether  the  fir-balsam  pillow  is  really 
quieting  and  beneficial  to  a  restless,  nervous  child?  If  so, 
where  can  it  be  obtained? 

The  fir-pillow  is  an  ''esthetic"  fancy  much  used  as  a  lounge 
ornament  in  towns.  The  odor  of  the  fir-balsam  is  to  many 
persons  very  grateful.  The  emanations  of  evergreen  trees 
have  been  sometimes  thought  to  be  beneficial  to  those  suffer- 
ing from  pulmonary  complaints,  but  their  value,  as  distin- 
guished from  that  of  the  surrounding  health-giving  circum- 
stances, is  not  proven.  It  is  possible  that  a  nervous  child 
might  be  pleased  with  the  odor  of  the  pillow,  and  so  quieted, 
but  we  do  not  suppose  that  it  has  any  real  medicinal  value. 
The  ancient  pillow  of  hops  is  quite  as  efficient.  The  mate- 
rials for  filling  pillows  are  prepared  throughout  the  fir- 
bearing  regions  wherever  summer  visitors  go.  The  cost  is 
slight. 

OBJECTIONS  TO   HAVING  CHILDREN   SLEEP 
WITH  ADULTS 

Is  it  detrimental  to  the  health  of  a  child  three  years  of  age  to 
sleep  with  a  grandmother  of  eighty?  And  if  so,  in  what  way 
is  it  injurious? 

We  think  it  wiser  that  children  sleep  by  themselves  when 
practicable.  There  is  a  prevailing  belief  that  it  is  not  wise 
for  the  young  to  sleep  with  the  old,  but  the  reasons  given  for 
it  smack  more  of  superstition  than  science.  The  real  ground 
of  objection,  Ave  think,  is  this:  The  aged  often  will  not,  and 
perhaps  from  habit  cannot,  bear  the  amount  of  fresh  air  and 
ventilation  that  nowadays  we  think  best  for  children  as 
well  as  adults.  In  addition,  they  are  apt  to  overburden 
the  bed  with  wrappings,  which  does  not  conduce  to  the  best 
sleep. 


320  THE  CENTURY  BOOK  FOR  MOTHERS 

POSITION   FOR  SLEEP 

What  is  the  best  position  for  a  baby  to  sleep  in? 

In  our  judgment,  what  is  called  by  physicians  the  ''semi- 
prone''  posture  is  most  natural  to  babies,  as  to  the  inferior 
animals— i.  e.,  on  the  side,  but  with  the  back  turned  a  little 
up.  In  this  position  a  slight  turn  of  the  head  makes  breath- 
ing easy,  and  the  weight  of  the  abdominal  organs  rather  helps 
than  hinders  respiration. 

SLEEPING   ON  THE  STOMACH 

Is  it  harmful  for  a  child  to  sleep  on  its  stomach? 

We  have  seen  many  infants  and  children,  and  some  adults, 
who  had  the  habit  of  sleeping  on  the  stomach,  and  have 
never  kno\Mi  any  harm  to  come  from  it.  Provided  they  do 
not  bury  their  faces  in  the  pillows  in  a  way  to  prevent  their 
having  sufficient  air,  we  do  not  know  what  harm  is  likely  to 
result.  It  is  easy  to  see  why  sleeping  upon  the  side  is  easier 
to  most  of  us  than  in  any  other  position,  but  if  a  child  is 
more  comfortable  lying  on  the  breast  and  abdomen  w^e  should 
let  it  alone.  The  observation  of  habits  of  the  domestic  ani- 
mals would  reassure  you.  If  you  have  a  house-dog,  notice 
how  he  will  sleep  upon  his  side  or  flat  dowm  upon  his  stomach, 
with  his  head  upon  his  forepaws.  The  cat  will  sleep  in  any 
position,  side,  stomach,  or  back,  and  all  without  any  damage. 

THE   CAUSES   OF   NIGHT  TERROR 

My  little  boy  of  five  years  is  greatly  troubled  with  bed-wetting. 
He  is  taken  up  at  10  p.m.,  but  he  invariably  needs  changing 
of  garments  and  bed-clothing  at  least  once  before  morning,  and 
very  often  twice.  Our  physician,  suspecting  some  irritation, 
performed  the  operation  for  phimosis  on  him  last  June,  from 
which  he  has  been  extremely  tender  ever  since,  the  parts  even 
at  times  approaching  rawness  on  the  under  side.     He  also  has 


SLEEPING  321 

severe  forms  of  nightmare,  screaming  out  in  apparent  delirium, 
with  eyes  wide  open,  bright,  and  dilated.  His  whole  form  is 
trembling  violently,  and  he  presses  together  his  thumbs  and 
fore-fingers,  as  if  in  the  act  of  picking  up.  We  always  take 
him  to  a  lighted  room  and  talk  gently,  and  he  always  answers 
our  questions  intelligently  in  one  breath,  and  in  the  next 
screams  again  at  his  imaginary  visions.  He  generally  comes 
out  all  right  in  about  ten  minutes. 
Can  you  tell  me  if  there  is  any  connection  between  the  irritation 
resulting  in  bed-wetting  and  the  nervous  condition  causing  the 
nightmare?  I  forgot  to  mention  we  are  confident  these  dis- 
turbances are  not  caused  by  anything  he  has  eaten,  as  they 
occur  on  going  to  bed  after  having  no  supper.  Is  he  liable 
to  outgrow  these  troubles,  or  does  he  need  treatment  at 
once? 

The  night  terror  may  possibly  be  due  to  the  sensitiveness  of 
the  prepuce,  but  it  is  more  likely  not  so,  for  the  form  of  the 
terror  is  the  usual  one,  and  we  think  that  if  it  v^ere  due  to 
conscious  irritation  at  that  point  he  would  be  likely  to  put 
his  hand  to  the  irritated  part.  In  spite  of  your  confidence 
that  the  terrors  are  '^not  caused  by  anything  he  has  eaten," 
we  should  urge  you  to  consider  his  dietary.  For  it  is  not 
necessary  that  the  offending  substance  should  have  just  been 
eaten  to  cause  trouble.  It  may  not  be  an  acute  indigestion, 
but  a  general  condition.  Thus,  some  children  with  very 
good  digestions  do  have  too  much  nitrogenous  food — meat, 
eggs,  or  milk— for  their  easily  excited  nervous  systems. 

It  is,  further,  wise  to  prevent  or  cure  the  foreskin  irritation 
if  possible.  The  best  preventives  are :  making  sure  that  the 
parts  are  thoroughly  dry  after  each  passage  of  urine,  and 
seeing  that  the  tender  place  is  not  irritated  by  any  garments. 
Besides,  the  use  of  soothing  powder  or  ointments,  of  which 
bismuth  powder  or  zinc  ointment  are  good  examples,  will  tend 
to  heal  any  existing  irritation.  It  is  true  that  children  do 
usually  escape  from  these  night  terrors  as  they  grow  older, 
but  we  would  suggest  watching  carefully  for  any  convulsive 
movements,  and,  if  noticed,  consult  the  physician  again. 

21 


322  THE  CENTURY  BOOK  FOR  MOTHERS 

WORMS   AS   POSSIBLE  CAUSES   OF   TALKING   IN  SLEEP 

I  have  a  little  boy,  three  years  of  age,  who  has  the  habit  of  talk- 
ing in  his  sleep.  He  does  not  seem  to  be  troubled  with  night- 
mares, for  he  very  rarely  shrieks;  but  he  often  talks  quite 
loudly,  and  generally  "grinds  his  teeth."  Some  months  ago 
I  mentioned  the  matter  to  a  physician,  who  thought  it  might 
be  nervousness,  and  believed  it  would  soon  pass  away.  One 
of  my  neighbors  thinks  his  restlessness  at  night  may  be  caused 
by  worms.  It  is  for  various  reasons  not  easy  for  me  to  send 
for  a  physician,  the  nearest  being  several  miles  distant.  Can 
you  suggest  a  remedy,  or  at  least  a  cause,  for  the  trouble 
mentioned  ? 

Perfect  health  in  children  is  generally  accompanied  by  per- 
fect sleep.  Some  kinds  of  broken  sleep  are  very  suggestive  of 
certain  ailments ;  but  this  is  not  true  of  all.  The  symptoms 
described  in  the  inquiry  are  not  very  distinctive.  The  age 
of  the  child  makes  it  probable  that  all  irritation  from  the 
teeth  is  past.  The  fact  that  the  sleep-talking  is  already  a 
habit  excludes  the  idea  that  it  is  indicative  of  the  approach 
of  any  acute  disease.  The  cause,  then,  is  probably  some- 
thing chronic  or  persistent  in  its  nature.  Of  this  sort  there 
are  a  great  many,  and  the  exact  one  can  often  be  discovered 
only  by  careful  inquiry  into  the  details  of  the  child's  regi- 
men. A  child  may  be  made  restless  or  talkative  in  sleep  by 
any  of  the  causes  which  produce  similar  conditions  or  only 
dreams  in  adults,  and  a  dream  may  be  very  disturbing  to  a 
child  without  reaching  the  terror  of  a  nightmare.  Among 
these  common  causes  we  may  mention  difficult  or  painful  di- 
gestion due  to  errors  either  as  to  the  kind  of  food  or  as  to 
the  time  of  its  administration,  discomfort  from  an  overheated 
sleeping  apartment  or  too  much  covering,  or  the  reverse  con- 
ditions. Any  form  of  mental  excitement  during  the  day,  and 
especially  during  the  latter  part  of  the  day,  has  a  similar 
effect.  There  are  a  multitude  of  other  little  details  that  need 
to  be  looked  to  before  the  cause  can  be  positively  ascertained. 
As  to  the  importance  of  worms  as  a  cause  of  the  symptoms 


SLEEPING  323 

described  and  of  many  others,  popular  belief  is  far  more 
closely  in  agreement  than  the  opinions  of  medical  men. 
AVithout  pretending  to  settle  a  vexed  question,  we  may  give 
what  we  think  a  fair  statement  of  the  matter.  The  frequency 
of  worms  varies  greatly  in  different  localities ;  and  apparently 
there  is  a  similar  difference  in  the  severity  of  the  affections 
caused  by  their  presence.  The  particular  worms  most  com- 
mon in  children  are  the  'Hhread"  or  ''pin"  worm,  and  the 
larger  lumbricoid  or  "round-worm."  The  local  irritation 
from  the  former  is  very  evident,  and  it  often  prevents,  as 
well  as  disturbs,  sleep ;  but  remoter  and  general  disturbances 
are  rarely  attributed  to  this  kind  of  worm.  Its  presence  can 
usually  be  determined  by  careful  ocular  inspection.  It  is  the 
"round- worm"  that  plays  such  a  great  part  in  popular 
pathology.  Now,  while  it  is  doubtless  a  fact  that  the  pres- 
ence of  this  worm  in  the  intestine  does  often  cause  general 
disturbance,  it  is  certain  that  it  does  so  far  less  frequently 
than  is  commonly  supposed.  It  is  very  often  present  with- 
out any  particular  disturbance  of  health  being  noticed;  and 
it  may  be  said  that,  of  all  the  so-called  symptoms  of  worms, 
there  is  not  one  that  may  not  be  due  to  some  other  cause. 
Even  when  ocular  inspection  has  established  the  presence  of 
the  worms,  it  may  be  that  they  are  not  the  cause  of  the  symp- 
toms attributed  to  them,  and  treatment  beyond  the  removal 
of  the  parasites  may  be  necessary.  This  symptom  of  dis- 
turbed sleep,  with  "grinding  of  the  teeth,"  is  probably  one 
of  the  most  constant  with  children  suffering  from  lumbri- 
coids,  but  it  may  also  be  constant  in  any  chronic  disturbance 
of  the  bowels ;  and  a  physician  may  really  consider  the  pres- 
ence of  the  worms  only  a  coincidence  or  a  complication  of  the 
bowel  troubles,  while  the  nurse  is  sure  that  it  is  at  the  root 
of  the  whole  matter.  It  is  therefore  inadvisable  to  give  a 
child  "worm-lozenges"  or  the  like  without  the  distinct  opin- 
ion of  a  physician,  who  can  also  advise  as  to  the  treatment 
of  coexisting  troubles  which  may  persist  even  if  the  worms 
be  discharged. 


XIV 
BATHING 

A  BATH  AT  NIGHT 

When  a  child  about  three  years  old,  able  to  play  out  of  doors  in 
the  grass  all  day  in  the  summer,  comes  in  at  night — of  course, 
very  dusty — is  it  advisable  to  give  the  daily  bath  then,  or 
would  a  slight  sponge-bath  at  night,  in  addition  to  the  morn- 
ing bath,  be  too  much? 

The  chief  difficulty  about  giving  the  bath  at  evening  is  this: 
The  child  comes  in  tired  and  hungry  as  well  as  dusty,  and 
wishes  to  eat  and  then  probably  to  sleep.  The  bath  cannot 
be  given  immediately  after  eating,  and  to  keep  him  hungry 
until  after  the  bath  may  precipitate  a  domestic  storm.  For 
these  reasons  (not  for  phj^siological  ones)  we  think  the  light 
sponge-bath  will  be  found  less  fatiguing  to  the  child  and  to 
its  mother  than  the  other  plan,  and,  all  things  considered, 
probably  better. 

THE   EFFECTS  OF  COLD   AND  WARM   BATHS 

Can  you  tell  me  in  what  cases  cold  baths  are  beneficial  to  chil- 
dren ?  Are  they  strengthening  to  a  delicate  child  ?  Is  a  warm 
bath  weakening? 

The  constitutional  effects  of  baths  vary  with  the  temper- 
ature. Cold,  as  is  well  known,  if  it  does  not  exceed  the 
resisting  power  of  the  person,  is  a  tonic,  producing  in- 
creasing tissue  changes,  and  consequently  increased  nutri- 
tion.    The  cold  bath  shares  this  strengthening  power.     But 

324 


BATHING  325 

if  the  cold  is  too  great  or  too  long  in  its  application  the  ex- 
hilarating ** reaction"  does  not  take  place  fully  or  at  all; 
the  result  is  fatigue,  exhaustion,  or  even  severe  prostration. 
The  cold  bath,  moreover,  has  curative  value  under  some  cir- 
cumstances because  of  its  shock  to  the  system.  The  shower- 
bath,  the  douche,  and  a  variety  of  baths  in  which  a  current 
of  water  is  used  are  exaggerations  of  the  cold  bath,  inasmuch 
as  the  cold  and  the  shock  are  combined ;  and  the  same  is  true 
of  the  sea-bath.  The  cold  bath,  in  all  its  varieties,  is  chiefly 
used  as  a  tonic,  and  extensively  employed  for  children  who 
are  feeble.  It  seems  unnecessary  to  insist  that,  as  the  bath 
is  intended  to  strengthen  the  little  patient,  it  should  under 
no  circumstances  be  used  in  such  a  way  as  to  depress.  As- 
suming this,  we  may  mention  some  of  the  conditions  under 
which  it  is  likely  to  prove  beneficial.  Children  who  have  a 
sluggish  circulation,  with  poor  appetite  and  feeble  digestion, 
are  often  markedly  benefited  by  systematic  cold  bathing.  So 
also  are  children  who  are  constantly  ''taking  cold"  and  chil- 
dren suffering  from  rickets.  Furthermore,  in  some  kinds  of 
nervous  ailments,  such  as  St.  Vitus 's  dance  (chorea),  as  also 
the  peculiar  crowing  croup  seen  most  frequently  in  rickety 
children,  cold  bathing  is  useful,  but  in  these  instances  it 
should  not  be  used  without  medical  sanction. 

The  warm  bath  is  not  stimulating,  but  relaxing.  It  pro- 
duces a  fulness  and  increased  color  of  the  skin,  due  to  the 
greater  amount  of  blood  brought  to  it.  A  warm  bath  is  at 
first  agreeable,  but,  if  prolonged,  enervating.  The  hot  bath 
produces  like  results,  but  in  a  higher  degree ;  and  if  the  tem- 
perature be  near  110°  it  can  be  borne  but  a  short  time  with- 
out causing  excited  action  of  the  heart  and  other  disagreeable 
symptoms.  These,  in  a  few  words,  are  the  principal  effects 
of  hot  and  cold  baths,  and  from  them  their  remedial  uses 
may  be  inferred. 

SOAP 

Is  the  use  of  soap  necessary  or  desirable  in  daily  baths?  For 
children's  use  which  is  preferable,  a  good  Castile  soap,  or  some 
of  the  numerous  "scented"  or  other  "fancy"  varieties? 


326        THE  CENTURY  BOOK  FOR  MOTHERS 

Soap  is  necessary  only  at  places  where  especial  need  of  clean- 
liness exists— face,  neck,  armpits,  seat,  and  groins.  But  as 
the  moderate  use  of  bland  soap  is  not  harmful  to  most  skins, 
it  is  easier  to  go  over  quickly  the  whole  or  most  of  baby's 
body  than  to  pick  out  spots  for  washing. 

' '  Castile, "  if  of  good  quality,  is  excellent.  There  are  other 
excellent  soaps  made.  But  avoid  scents.  Your  object  is  to 
clean  the  baby,  and  to  know  if  it  is  sweet  when  you  have 
finished  you  must  avoid  artificial  smells.  A  clean  baby  is 
sweeter  than  any  perfume. 


DIMINISHING   THE   FREQUENCY  OF   BATHS 

When  shall  baby's  daily  bath  be  discontinued?  Never,  I  hear 
some  say;  but  suppose  the  mother's  time  and  strength  are  very 
much  taxed? 

If  a  change  is  to  be  made,  how  many  baths  should  be  given 
a  week,  and  are  they  to  be  given  night  or  morning? 

You  answer  this  question  yourself.  It  is  to  be  continued 
as  long  as  you  can  give  it.  It  is  given  in  the  main  for  clean- 
liness, and  is  no  more  necessary  at  six  months  than  at  six 
years.  The  immersion  is  not  a  necessary  part  of  the  bath. 
A  quick  sponging  does  as  well. 

As  many  as  you  can  give.  If  you  can  give  only  three 
baths  a  week,  or  two,  or  even  one,  give  them.  They  are  pref- 
erable in  the  morning,  as  a  cool  sponging  is  a  protection 
against  taking  cold,  and  the  exposure  is  more  likely  to  occur 
by  day  than  by  night. 

THE  OUTING   AFTER  A   BATH 

How  long  after  a  bath  should  a  baby  be  kept  indoors  ?  My  baby 
is  nine  months  old;  she  usually  sleeps  till  eight  or  later.  I 
give  her  a  bath  at  once,  letting  her  sit  two  or  three  minutes 
in  water  at  90°.  Lately,  after  wrapping  her  in  her  blanket, 
I  have  sponged  her  in  water  at  50°  before  drying  and  rubbing. 
She  enjoys  it  all  and  is  warm  afterwards. 


BATHING  327 

Last  winter  I  sometimes  took  her  out  in  an  hour.  If  she  slept 
till  nine,  and  I  went  out  in  the  forenoon,  I  could  not  wait 
longer.  But  I  feared  it  was  hardly  safe,  though  she  has  never 
taken  cold  in  consequence,  and,  indeed,  has  never  had  a  severe 
cold.  When  a  little  baby  she  wakened  at  5  a.m.,  had  her  bath 
at  eight,  and  was  fed  afterwards.  But  she  would  never  take 
a  long  nap  after  her  bath,  often  none  at  all. 

AA^e  believe  that  after  a  bath  at  90°  the  child  could  as  safely 
go  out  in  an  hour  as  at  any  time— supposing  it  fit  weather 
to  go  out  at  all.  If  she  is  sponged  in  vv^ater  at  50°,  we  believe 
that  she  could  go  out  as  soon  as  dressed,  w^ith  the  same  pre- 
sumption as  to  weather. 


XV 

TEETHING 

IS  NORMAL  TEETHING   PAINLESS? 

I  would  like  to  ask  if  the  teething  of  healthy  children  is  with- 
out pain  or  discomfort?  I  am  no  believer  in  the  theory  that 
every  derangement  of  the  system  during  dentition  is  attribu- 
table to  that  as  a  cause,  but  after  an  experience  with  three 
strong,  healthy  babies  of  my  own  I  cannot  readily  accept  the 
theory  that — as  one  physician  expressed  it — "dentition  is  as 
painless  a  process  as  the  growing  of  the  finger-nails." 

My  little  six-year-old,  just  cutting  the  "seven-year  molars," 
complains  frequently  of  soreness  and  discomfort  of  the  gums. 
Is  it  irrational  to  believe  that  a  younger  child,  with  less  vigor 
for  endurance,  suffers  equal  discomfort  in  cutting  the  first 
teeth,  and  that,  using  the  only  means  of  expression  at  his 
command,  he  becomes  fretful  and  peevish,  gradually  develop- 
ing more  or  less  f everishness  in  consequence  of  the  discomfort  ? 

My  youngest  child,  whose  dentition  has  been  very  slow,  cut  her 
third  incisor  when  she  was  fourteen  months  old.  For  weeks  the 
tooth  had  seemed  so  near  the  surface  that  I  expected  every  day 
to  feel  its  edge.  Then  the  gum  became  inflamed,  the  covering 
skin  was  hard  and  tightly  drawn,  the  child  fretful.  On  the 
fourth  or  fifth  day  I  discovered  a  small  gathering  of  pus  at 
one  corner  of  the  uncut  tooth.  I  sent  for  my  physician,  who 
lanced  the  gum,  freeing  the  tooth  and  giving  immediate  relief 
to  the  child.  Is  such  an  experience  unusual,  and  what  is  the 
probable  cause  of  the  pus?  The  child  has  no  tendency  to 
humor  of  any  kind,  and  at  the  time  was  in  her  usual  health. 
Could  such  a  case  be  attributed  to  derangement  of  stomach  or 
bowels,  or  was  I  right  in  considering  it  an  incident  of  den- 
tition ? 


TEETHING  329 

Let  us  put  it  in  another  way.  Not  'Hhat  the  teething  of 
healthy  children  is  without  pain  and  discomfort,"  but  that 
pain  and  discomfort— if  unusually  great— are  at  least  pre- 
sumptive evidence  that  the  process  of  the  evolution  of  teeth  is 
not  going  on  in  a  normal  or  healthy  way.  This  change  is 
not  a  quibble,  but  a  different  point  of  view.  For,  first,  the 
phrase  ''a  perfectly  healthy  child"  has  no  meaning  unless 
that  judgment  has  been  passed  by  a  competent  authority. 
We  recall  scores  of  children  so  described  to  us  who  were, 
to  our  mind,  anything  but  healthy.  Further,  in  practice  we 
have,  not  so  very  rarely  either,  been  asked  to  admire  as  evi- 
dence of  unusual  health  or  strength  what  we  considered 
marks  of  disease.  Apparently  w^hat  is  generally  meant  by 
the  phrase  ''perfectly  healthy"  is  that  the  person  described 
does  not  come,  or  at  least  comes  rarely,  under  medical  care. 
In  adult  life  persons  who  attend  without  complaint  to  their 
daily  avocation  are  considered  "perfectly  healthy,"  although 
one  may  have  chronic  constipation,  another  frequent  head- 
aches or  oft-repeated  neuralgic  affections,  while  another  may 
have  all  the  obscurer  manifestations  of  gout,  but  escape  the 
typical  swollen  toe,  and  so  on  to  the  end  of  the  chapter. 

Now,  the  change  of  view  regarding  teething  which  has 
come  to  the  great  majority  of  physicians  who  especially  study 
children's  diseases  is  not  that  they  do  not  think  that  the 
baby  suffers  or  that  they  do  not  sympathize  with  its  suf- 
ferings, but  that  they  no  longer  think  that  this  suffering  is 
natural  or  normal.  If  the  child  suffers  much  from  denti- 
tion, even  locally,  they  think  that  the  child  is  not  entirely 
well,  or  the  reaction  of  a  physiological  process  would  not  be 
so  severe.  Very  often  indeed  one  skilled  in  children's  ail- 
ments can  point  out  where  the  deviation  from  health  is 
which  probably  underlies  the  troublesome  dentition.  We  do 
not  say  that  it  *'is  as  painless  a  process  as  the  growing  of 
the  finger-nails,"  but  many  experts  at  least  will  be  inclined 
to  say  that  in  health  it  ought  to  be.  There  is  no  manner  of 
doubt  that  children's  gums  are  often  painful  at  dentition— 
we  do  not  here  discuss  the  remoter  ailments  often  charged 


330       THE  CENTURY  BOOK  FOR  MOTHERS 

to  dentition— but  it  is  doubtful  if  the  pain  ought  to  be  of 
such  a  nature  as  to  disturb  sleep  or  to  cause  any  great  dis- 
comfort. Take  a  case  from  your  own  letter.  Your  little 
one  cuts  its  third  incisor  at  the  age  of  fourteen  months,  a 
delay  so  great  as  to  be  of  itself  sufficient  cause  for  looking 
the  child  over  carefully  for  a  disordered  condition  of  nutri- 
tion to  account  for  it.  Then  an  abscess  forms  in  the  gum. 
This  shows  very  unusual  irritation,  and,  according  to  our 
present  belief,  pus  cannot  form  unless  the  necessary  micro- 
organism has  been  introduced,  in  this  case  probably  from 
without.  The  occurrence  was  ''an  incident"  (or  rather  acci- 
dent) "of  dentition."  It  was  probably  not  due  to  any  tem- 
porary derangement  of  stomach  and  bowels,  but  rather  pri- 
marily to  that  peculiarity  of  system  which  delayed  dentition, 
and,  as  we  said  before,  to  the  introduction  of  one  or  other 
of  the  pus-exciting  organisms  into  the  tissue,  most  likely  from 
without  through  handling  the  gum  or  the  chewing  upon  some 
substance,  as  teething  children  often  do. 

The  change  in  view,  we  have  said,  leads  not  to  any  doubt 
of  the  baby's  suffering,  but  to  giving  greater  attention  to  his 
condition— to  the  condition  before  and  during  teething,  with 
the  view  of  preventing  pain  and  illness. 

If  the  question  is  asked :  What  does  it  matter  to  us  in  the 
nursery  whether  the  many  disorders  attending  teething  are 
caused  by  it  or  not  ?  we  answer  just  this :  If  the  parents  be- 
lieve that  dentition  causes  all  the  ailments  attributed  to  it, 
they  are,  as  we  daily  see,  prone  to  consider  the  ailments  as 
nearly,  if  not  quite,  as  much  a  matter  of  course  as  the  natu- 
ral teething  process,  and  they  consider  it  useless  to  try  to 
cure  them  until  teething  is  complete.  Moreover,  by  a  sort 
of  inverse  reasoning,  if  any  of  the  disorders  which  they  are 
accustomed  to  regard  as  dependent  upon  dentition  happen 
to  exist,  they  infer  that  the  child  is  teething,  whether  he 
be  so  or  not.  As  a  result  of  all  these  errors  and  confusions, 
it  too  frequently  happens  that  disorders  which  might  have 
been  very  tractable  at  the  outset  are  allowed  to  progress  un- 
opposed until  they  reach  a  serious  stage.     If,  on  the  con- 


TEETHING  331 

trary,  we  assume  that  teething  is  rarely  the  real  cause  of 
disease,  the  parent  will  seek  some  other  reason  for  any  dis- 
turbance of  the  system  that  may  exist,  and  will  endeavor  to 
remove  it,  either  with  or  without  the  aid  of  a  physician.  The 
difference  of  opinion  is  then  not  a  simple  dispute  of  terms, 
but  one  which  has  a  practical  interest  in  the  nursery. 


LATE  TEETHING 

I  cannot  think  that  my  baby  had  any  tendency  to  rickets,  as 
he  was  exceptionally  strong  and  robust,  but  when  a  year  old 
he  had  only  two  teeth,  and  did  not  get  the  stomach  and  eye 
teeth  until  two  years  and  a  half  old.  He  seems  to  have  good 
teeth,  and  I  had  somewhere  imbibed  the  idea  that  late  teeth- 
ing made  good  teeth,  as  I  knew  of  four  children  who  got  no 
teeth  until  about  a  year  old,  all  of  whom  had  beautiful  teeth 
in  after  years.     Do  you  consider  late  teething  as  unhealthf ul  ? 

Some  normal  differences  exist  as  to  the  time  of  teething— the 
medical  books  set  seven  months  as  an  average  for  the  first 
tooth  to  show,  but  many  children  begin  two  or  three  months 
earlier,  and  some  later.  Late  teething  is,  by  common  agree- 
ment of  all  who  have  studied  the  subject,  one  of  the  signs  of 
rickets,  and  it  is  a  sign  easily  noticed  by  the  mother,  while 
she  might  overlook  others.  Rickets  in  its  less  marked  forms 
is  one  of  the  commonest  disorders  of  early  childhood,  and  one 
which  seems  to  be  habitually  overlooked  unless  it  has  ad- 
vanced to  the  degree  of  producing  deformities. 

Late  teething  is  never  an  advantage.  A  child's  teeth  may 
be  delayed  by  rickets,  and,  after  his  recovery,  come  through 
in  good  enough  shape,  and  the  second  set  of  teeth  may  es- 
cape damage  altogether.  The  late  examples  you  speak  of 
were  probably,  to  judge  from  the  usual  course  of  such  cases, 
children  who  were  kept  on  breast  milk  which  was  really  not 
up  to  the  mark,  and  only  after  weaning  did  they  get  mate- 
rial with  which  to  push  their  teeth,  or,  if  bottle-babies,  they 
had  at  length  become  accustomed  to  their  food. 


332  THE  CENTURY  BOOK  FOR  MOTHERS 

On  the  other  hand,  late  teething  alone— i.  e.,  unaccom- 
panied by  any  other  evident  derangement  of  health— cannot 
be  accounted  a  disease.     It  is  frequently  a  family  peculiarity. 

DROOLING 

Can  anything  be  done  to  stop  a  child's  "drooling"?  My  boy, 
now  nearly  two  years  old,  has  drooled  constantly  since  two 
months  old.  He  had  no  teeth  until  he  was  seven  months  old, 
and  now  has  sixteen.  He  got  the  bottle  until  a  year  old.  He 
is  not  unnaturally  thirsty,  but  likes  something  wet  in  his 
mouth,  and  never  loses  an  opportunity  to  take  a  wet  cloth  or 
sponge.  I  have  spoken  about  it  to  two  good  physicians,  but 
they  seem  to  regard  it  lightly,  and  tell  me  I  may  be  thankful 
nothing  of  importance  is  the  matter  with  him.  Let  me  say 
that  the  child  is  as  forward  in  everything  as  others  of  his  age. 
Are  such  cases  of  drooling  not  very  unusual? 

We  may  say  first,  to  relieve  your  anxiety,  that  the  ailment 
in  all  probability  ''is  nothing  more  serious  than  an  annoy- 
ance." Quite  evidently  something  has  overstimulated  the 
salivary  glands,  and  the  child's  desire  to  take  wet  things 
into  his  mouth  suggests  that  he  is  conscious  of  an  irritation 
of  the  gums.  Very  probably  the  remaining  teeth  of  the  tem- 
porary set  are  in  process  of  eruption,  and  when  this  is  over 
the  irritation  will  cease.  Another  possible  cause  is  this:  If 
there  is  any  obstruction  to  free  breathing  through  the  nostrils, 
the  opening  of  the  mouth  may  stimulate  the  flow  of  saliva. 
At  all  events,  such  cases  of  constant  drooling  are  not  rare. 


XVI 
THE  TEETH 

STRENGTHENING  THE  TEETH 
What  food  is  best  for  strengthening  the  teeth? 

If  there  is  no  evident  disease  of  the  teeth,  the  best  way  to 
insure  continued  soundness  is  not  to  give  any  one  thing 
supposed  to  be  strengthening  to  the  teeth,  but  a  good,  whole- 
some diet,  and,  above  all,  to  avoid  the  use  of  those  things 
known  to  damage  the  teeth.  The  articles  of  food  most  likely 
to  injure  teeth  are  probably  those  the  digestion  of  which, 
either  generally  or  in  the  particular  instance  of  the  person 
concerned,  are  found  to  promote  acidity  of  the  stomach.  Of 
course  careful  attention  to  the  toilet  of  the  mouth  is  assumed, 
and  the  care  of  a  dentist  whenever  his  services  may  be  needed. 
Actual  disease  of  the  teeth  can  rarely  be  controlled  without 
his  attention.  We  may  add  a  word  concerning  the  teeth  of 
young  children.  It  is  of  advantage  to  keep  an  infant's  teeth 
clean  in  the  same  way  as  an  adult's  teeth  are  so  kept.  If 
teeth  are  already  decayed  they  should  be  carefully  attended 
to,  and  the  decay  hindered  by  cleanliness  after  each  meal. 
If  teeth  are  defective  in  structure,  with,  for  instance,  thin 
or  irregularly  absent  (''worm-eaten")  enamel,  it  is  doubtful 
if  anything  can  be  done  to  strengthen  these  particular  teeth, 
but  coming  teeth  may  be  helped  by  care  of  the  general  health, 
and,  as  many  believe,  by  the  use  of  the  lime  salts,  particu- 
larly the  phosphate.  The  hypophosphite,  generally  found  in 
the  drug-shops  in  the  form  of  a  syrup,  seems  to  be  of  some 

333 


334       THE  CENTURY  BOOK  FOR  MOTHERS 

use.  The  same  may  be  said  of  the  syrup  of  the  lacto-phos- 
phate  of  lime,  and  some  judicious  practitioners  still  esteem 
the  powder  of  phosphate  of  lime,  and  even  the  powder  of 
ground  bone. 

EFFECT  OF   EARLY  FEEDING  UPON  THE  TEETH; 
THE   USE   OF   THE  TOOTH-BRUSH 

I  have  heard  as  coming  from  a  physician  that  feeding  a  baby 
very  early,  before  the  nursing  period  was  ended,  had  a  ten- 
dency to  injure  the  material  of  the  coming  teeth.  What  can 
you  tell  me  about  it? 

Should  a  child's  first  teeth,  as  soon  as  they  are  well  matured,  be 
brushed  with  a  tooth-brush  or  simply  washed  as  the  mouth  has 
been  washed  before? 

Any  improper  feeding  before  or  after  the  discontinuance  of 
nursing,  or  even  nursing  when  the  milk  is  impoverished,  may 
lead  to  rickets  and  to  imperfect  teeth  as  a  result.  The  ques- 
tion is  as  to  the  kind  of  food,  rather  than  the  mere  fact  of 
feeding. 

The  tooth-brush  will  not  harm  the  teeth  directly,  but  it 
may,  especially  if  stiff,  injure  the  gums  and  secondarily  the 
teeth.  Little  children,  and  especially  babies,  do  not  usually 
like  to  have  their  teeth  brushed,  and  struggle  against  the 
performance.  It  is,  therefore,  difficult  to  apply  the  brush  as 
accurately  as  could  be  desired.  Consequently,  to  avoid  the  in- 
jury to  the  gums  spoken  of,  we  think  the  washing  preferable. 

EARLY   DECAY  OF  TEETH 

My  baby  boy,  seventeen  months  old,  has  fourteen  teeth.  The 
first  ones  already  show  signs  of  decay.  What  is  the  cause  of 
this,  and  can  it  be  arrested?     If  so,  how? 

By  all  odds  the  commonest  cause  is  faulty  nutrition,  which 
may  exist  whether  the  child  is  nursed  or  fed.  If  the  defects 
are  localized,  your  dentist  can  do  much  to  preserve  the  teeth 


THE  TEETH  335 

by  careful  attention.  If  the  decay  is  general,  involving  the 
whole  surface  of  the  teeth,  he  can  do  less  or  little.  But  he 
should  by  all  means  be  consulted  and  allowed  to  judge 
whether  or  not  the  case  is  one  which  he  can  benefit.  The  ex- 
pense will  be  well  repaid  by  the  improvement  in  the  child's 
freedom  from  toothache  and  in  the  better  condition  of  the 
coming  set. 

DISCOLORATION  OF  THE  TEETH 

My  baby  is  two  years  and  a  quarter  old.  He  has  been  very 
slow  cutting  his  teeth,  the  last  ones  (his  stomach  teeth)  hav- 
ing come  through  two  weeks  ago.  About  two  months  ago  I 
noticed  his  four  front  upper  teeth  were  turning  dark;  the  dis- 
coloring now  covers  more  than  half  the  upper  part  of  them. 
He  has  always,  though  very  good  about  everything  else,  fought 
against  taking  a  drink  of  water  and  having  his  mouth  washed, 
consequently  it  has  been  very  imperfectly  done.  Could  that 
cause  the  trouble,  or  does  it  come  from  acidity  of  the  stomach, 
from  which  he  suffered  greatly  the  first  year? 

If  the  discoloration  is  only  a  superficial  one— that  is,  simply 
the  greenish  stain  often  seen  on  the  teeth — it  is  probably  due 
to  the  neglect  of  cleansing.  The  fact  that  the  discoloration 
is  on  the  upper  half  of  the  teeth  makes  this  more  likely.  But 
we  ought  to  say  that  the  same  physical  peculiarity  that  favors 
late  teething  also  is  attended  with  stomachic  disorders  and 
discoloration  and  early  decay  of  the  teeth ;  so  this  is  a  matter 
to  be  looked  into.  The  damage  to  the  teeth  does  not  come 
immediately  from  the  acidity  of  the  stomach,  but  they  are 
associated  manifestations  of  one  cause. 


PECULIARITY  OF  TEETH 

My  baby,  nearly  two  years  old,  is  perfectly  well.  Her  little 
tongue  is  as  red  and  smooth  as  possible,  but  she  has  several 
small  spots,  depressions,  somewhat  discolored,  on  the  face  of 
the  front  upper  two  teeth.  This  peculiarity  exists  in  her 
father's  family,   the  front  teeth   of  several  of  the  members 


336  THE  CENTURY  BOOK  FOR  MOTHERS 

being  short,  strong,  and  healthy,  but  not  perfectly  white,  and 
having  these  discolored  depressions,  about  the  size  of  a  small 
pin-head.  Can  anything  be  done  to  prevent  the  second  set 
from  appearing  the  same  way?  She  has  had  eighteen  teeth 
for  six  or  eight  months  past. 

This  peculiarity  of  the  teeth  is  well  known.  We  recall  fami- 
lies where  it  is  found  in  parents  and  children,  having  existed 
from  childhood  in  the  parent.  Now,  whether  the  peculiarity 
is  a  hereditary  one  in  the  strict  sense,  or  whether  some  nutri- 
tional peculiarity  that  has  caused  it  in  two  generations  is  the 
heredity,  or  whether  it  is  simply  due  to  some  traditional  (and 
in  one  sense  hereditary)  method  of  feeding  we  cannot  deter- 
mine. We  incline  to  the  second  supposition.  The  fact  of 
their  existence  in  the  primary  teeth  does  not  determine  their 
reappearance  in  the  second  set.  We  know  of  nothing  except 
general  good  hygiene  that  is  useful.  Keep  the  child  as  well 
as  possible,  and  wait. 

REMOVING  REDUNDANT  OR   "EXTRA"  TEETH 

My  little  daughter,  twenty-three  months  old,  has  a  redundant 
incisor  tooth  which  came  through  three  months  ago,  forcing 
its  way  painfully  between  the  two  upper  incisors  on  the  left 
side  of  her  face.  The  back  one  of  these  incisors  pierced  the 
gum  a  little  higher  up  and  farther  back  than  the  correspond- 
ing tooth  on  the  right  side,  thus  leaving  a  space  between  the 
left  incisors  about  half  the  width  of  a  tooth.  The  redundant 
incisor  cut  through  this  space  obliquely,  with  the  edge  of  the 
tooth  directed  to  the  left  and  outward  instead  of  downward. 
It  is  disfiguring,  and  will,  I  fear,  crowd  the  other  teeth,  and 
I  do  not  wish  it  to  appear  in  the  permanent  set.  Will  you 
kindly  advise  me  how  soon  it  should  be  extracted,  also  if  the 
operation  will  be  attended  with  any  danger?  I  have  feared 
the  effects  of  an  anesthetic  on  so  young  a  child,  especially  as 
she  is  of  a  very  nervous  organization. 

Such  a  tooth  is  usually  removed  by  dentists  as  soon  as  it 
crowds  the  others,  or  when  they  think  the  proper  order  of 


THE  TEETH  337 

the  teeth  is  deranged  by  its  presence.  Whether  or  not  a 
supernumerary  tooth  will  appear  in  the  permanent  set  does 
not  depend  upon  the  extraction  of  the  present  tooth,  but 
upon  the  existence  or  absence  of  the  rudiment  of  that  per- 
manent tooth  in  the  jaw.  A  dentist  of  ordinary  skill  can 
extract  the  tooth  safely,  and  will  advise  you  if  he  needs  ad- 
ditional aid  in  giving  the  anesthetic,  if  indeed  that  is  neces- 
sary. The  simple  extraction  of  an  incisor  might  cause  less 
disturbance  than  the  administration  of  an  anesthetic.  If  a 
supernumerary  tooth  appears  in  the  second  set  the  dentist 
can  also  advise  concerning  its  removal. 


THE   FILLING  OF  THE  FIRST  TEETH 

Should  the  first  teeth  of  children  be  treated  just  like  teeth  of 
adults?  That  is  to  say,  should  a  cavity  be  filled  and  the  tooth 
preserved  as  long  as  possible,  even  if,  in  the  natural  order  of 
things,  it  could  stay  only  a  year  or  two  longer? 

The  details  of  treatment  should,  of  course,  be  left  to  the  judg- 
ment of  the  dentist,  but  the  general  rule,  we  believe,  is  to 
continue  as  far  as  possible  the  usefulness  of  the  tooth  until 
it  is  replaced  by  its  successor.  Painful  filling  can  hardly  be 
done  to  the  teeth  of  little  folk,  but  something  in  the  way  of 
soft  filling  and  the  like  can  be  done.  This,  we  think,  not 
only  prevents  toothache,  but  enables  the  child  to  chew  prop- 
erly, and  also  gives  the  second  set  a  better  chance  of  per- 
fection. 


UNUSUAL  ABSENCE  OF  UPPER  INCISORS 

Have  you  ever  heard  of  a  child  failing  to  cut  the  upper  lateral 
incisors?  My  little  boy,  now  nearly  two  years  old,  has  cut  all 
of  his  teeth  except  these,  which  should  have  been  cut  a  year 
ago,  and  the  second  molars;  and  I  feel  very  much  afraid  that 
the  disfiguring  little  spaces  upon  each  side  of  the  two  front 
teeth  will  not  be  filled  up. 
22 


338  THE  CENTURY  BOOK  FOR  MOTHERS 

Yes.  Deficiency  in  the  number  of  teeth,  as  well  as  redun- 
dance, occurs.  Sometimes  there  is  a  symmetrical  absence  of 
teeth  in  the  first  set,  while  the  second  set  is  complete,  and 
sometimes  the  reverse  happens ;  or  both  sets  may  be  imperfect 
or  redundant. 


XVII 
THE  EYES 


SQUINT 

My  little  boy,  two  and  a  half  years  of  age,  has  from  infancy  had 
the  bad  habit  of  looking  over  his  head,  owing,  no  doubt,  to  a 
slight  cast  in  his  eyes.  About  three  months  ago  I  noticed  that 
he  turned  the  left  eye  in  very  slightly,  and  lately  it  has  be- 
come much  worse.  The  other  eye  is  slightly  affected,  too. 
Our  family  physician  says  the  eyes  may  become  all  right  later 
on,  and  that,  any  way,  an  operation  will  relieve  the  trouble; 
but  I  don't  want  to  think  of  such  a  necessity,  as  the  child  has 
lovely,  bright  eyes,  and  I  fear  they  may  be  injured  through 
the  operation.  Do  you  think  an  operation  is  necessary  in 
such  a  case?  Is  it  a  very  complicated  one  and  frequently 
done? 

Though  it  is  possible  that  occasionally  the  squint  may  be  reme- 
died by  means  short  of  an  operation,  yet  in  most  cases  the 
latter  procedure  becomes  necessary.  Sometimes,  though 
rarely,  the  use  of  proper  glasses,  which  correct  the  defect  of 
vision,  if  applied  early  enough,  may  cure  the  squint.  The 
operation  usually  resorted  to  is  not  a  very  formidable  one. 
If  the  child  is  old  enough  not  to  be  frightened  at  the 
sight  of  instruments,  cocaine  may  be  used  to  abolish  pain, 
and  thus  the  use  of  ether  be  obviated.  However,  in  most 
children  the  production  of  unconsciousness  by  a  general  anes- 
thetic, such  as  ether  or  chloroform,  is  necessary.  The  opera- 
tion consists  in  severing  the  muscle  the  over-action  of  which 
causes  the  squint,  or  in  severing  that  muscle  which,  through 

339 


340       THE  CENTURY  BOOK  FOR  MOTHERS 

the  weakness  of  its  opponent,  causes  deformity.  Sometimes 
the  operation  is  done  upon  one  side,  sometimes  it  is  neces- 
sary to  perform  it  upon  both  eyes.  The  severed  muscles  then 
attach  themselves,  or  are  attached,  further  back  upon  the 
eyeball,  and  thus,  having  diminished  leverage,  are  weaker 
than  they  were  before,  and  accordingly  allow  the  eyes  to 
assume  the  straight  position.  The  healing  after  the  opera- 
tion is  rapid. 

It  is  scarcely  necessary  to  dwell  upon  the  change  in  the 
appearance  of  the  child  after  the  operation  has  produced  the 
straightened  condition  of  the  eyes.  It  is  very  marked,  and 
sometimes  wonderful.  So  far  from  your  having  reason  to 
dread  an  injurious  effect  on  the  eyes,  the  operation  can  only 
improve  them.  The  operation  for  squint  is  probably  the 
most  frequent  of  all  the  operations  upon  the  eye  attempted  by 
the  oculist ;  it  is  also  one  of  the  most  certain  in  the  results  in 
skilled  hands,  and  hence  no  excuse  exists  for  allowing  a  child 
to  go  about  with  the  great  disfigurement  which  the  existence 
of  squint  entails. 

TEST  FOR  CROSS-EYES 

There  seems  to  be  some  defect  in  the  eyes  of  my  boy  of  five,  but 
I  cannot  exactly  call  it  a  squint.  Sometimes  he  looks  decid- 
edly cross-eyed  for  a  minute  or  so,  while  most  of  the  time  his 
eyes  are  quite  normal.     What  is  the  usual  test  for  detecting 

cross-eyes  ? 

The  test  most  commonly  employed  by  oculists  to  detect 
''cross-eyes"  or  ''squint"  is  to  cover  one  eye,  and  have  the 
child  look  with  the  other  at  the  examiner's  finger,  held  at  a 
distance  of  about  fifteen  inches  directly  in  front  of  the  child 
in  the  median  line;  if  this  be  done,  and  the  hand  covering 
the  eye  be  slightly  tilted  so  that  the  examiner  can  watch  the 
covered  eye,  the  latter  will  be  seen  to  roll,  or  move  inward 
or  outward,  according  to  the  nature  of  the  squint.  Then,  by 
suddenly  removing  the  hand  from  the  eye  previously  cov- 
ered, the  difference  in  the  direction  of  the  axes  of  the  two 


THE   EYES  341 

eyes  will  be  very  apparent;  the  observation  must  be  made 
quickly,  however,  since  the  squinting  eye  will  soon  correct 
its  position  so  that  its  axis  will  correspond  to  that  of  the 
other  eye,  and  both  will  then  become  fixed  upon  the  exam- 
iner's finger.  This  test  should  be  applied  first  upon  the  eye 
which  appears  to  squint,  and  then  upon  the  other  in  a  like 
manner. 

It  must  be  remembered  that  cross-eye,  at  the  commencement 
of  the  trouble,  is  often  present  only  at  certain  periods  and 
absent  at  others.  Also,  that  it  is  frequently  due  to  errors 
of  vision  which  may  be  corrected  by  the  fitting  of  proper 
glasses. 

NEEDLESS  ANXIETY   ABOUT   BRILLIANT   EYES 

Is  there  any  necessity  for  worry  because  a  baby  has  bright  eyes? 
This  seems  like  a  very  silly  question,  but  I  suffered  with  a 
complication  of  nervous  troubles  before  my  baby  was  born, 
and  have  been  especially  sensitive  about  him.  And  now  an 
officious  friend  has  "stirred  me  up";  on  first  seeing  my  beau- 
tiful, healthy  boy,  he  exclaimed,  "What  wonderfully  bright 
eyes  he  has!  Has  he  ever  had  anything  the  matter  with  his 
head?  No?  I  thought  he  might  have  had,  as  they  are  so 
very  bright!"  Under  the  circumstances  I  did  not  like  it,  to 
say  the  very  least. 

There  is  no  necessity  for  worry  whatever.  Nor,  as  far  as  you 
have  given  the  facts,  is  there  any  ground  for  anxiety.  If 
you  have  reason  to  suppose  your  baby  hereditarily  excitable, 
try  to  avoid  excitements  for  him.  Brilliancy  of  the  eye  is 
not  an  evidence  of  disease  by  itself. 

EYE-PUPILS  OF  DIFFERENT  SIZES 

How  serious  a  trouble  is  a  difference  in  size  of  the  pupils  of  the 
eyes,  or  how  serious  may  it  become?  What  may  be  done  to 
correct  it  or  its  cause?  My  boy  is  six  months  old,  and  the 
difference  in  his  pupils  is  very  marked  at  times.     When  the 


342  THE  CENTURY  BOOK  FOR  MOTHERS 

pupils  are  small  I  observe  no  difference,  and  for  a  time  have 
thought  the  direction  or  amount  of  light  had  the  effect  named, 
but  now  I  am  convinced  the  pupils  are  at  fault. 

The  difference  may  or  may  not  be  a  symptom  of  importance. 
Associated  with  other  disturbances  it  often  betokens  serious 
brain  troubles.  On  the  other  hand,  cases  are  met  with  where 
the  discrepancy  has  existed  from  birth  and  has  continued 
many  years  in  a  person  of  good  health,  who  is  unconscious  of 
any  disturbance  of  vision. 

STIES 

Our  little  girl  of  fourteen  months  has  had  twelve  sties  or  little 
boils  on  her  eyelids.  They  commenced  to  come  about  six  months 
ago,  a  little  before  I  weaned  her  and  just  after  the  first  teeth 
had  come  through;  she  now  has  eight  teeth.  During  the  last 
few  months  she  has  grown  thin,  but  of  late  seems  to  be  "pick- 
ing up"  again.  All  but  two  of  the  sties  came  on  the  tips  of 
her  lids,  both  upper  and  lower,  and  they  have  caused  her  to 
lose  nearly  all  of  her  eyelashes.  The  last  two  sties  seemed 
more  serious  than  the  others.  One  was  almost  on  the  side  of 
her  nose,  and  was  opened  four  times,  twice  by  myself  and 
twice  as  she  hit  it  with  her  hand,  each  time  discharging  much 
matter.  I  have  consulted  three  physicians,  but  they  have  not 
helped  her.    Can  you  tell  me  the  cause  ?    How  can  I  help  her  ? 

The  ordinary  causes  are  local  inflammatory  irritation,  acting 
upon  a  system  deranged  in  some  way,  especially  when  the 
patient  suffers  from  anemia  (thinness  of  blood),  or  is  of 
scrofulous  habit. 

The  general  condition  must  be  looked  to.  The  diet 
should  be  examined  to  ascertain  if  it  be  well  digested.  Iron 
may  be  needed,  or  perhaps  cod-liver  oil.  Locall}^  the  prompt 
opening  of  sties  as  they  occur  is  very  useful,  as  well  as  the 
careful  cleansing  of  the  lids.  Some  of  the  products  of  the 
inflammation  may  not  be  discharged  as  pus,  and  later  on  may 
excite  further  irritation  or  remain  as  an  indolent  mass  in  the 
lids.      These  are  the  general  principles  of  treatment.      Al- 


THE  EYES  343 

though  you  have  consulted  three  physicians,  we  still  think 
that  you  will  do  better  to  try  again  than  to  attempt  domestic 
treatment.  Pick  out  one  physician,  and  continue  with  him 
long  enough  to  find  out  what  he  can  do  and  to  give  him  some 
interest  in  his  little  patient. 

CLIPPING  THE  EYELASHES 

Is  it  true  that  clipping  the  ends  of  the  eyelashes  is  beneficial, 
and  is  it  likely  to  cause  them  to  grow  longer?  When  is  the 
proper  time  to  do  it? 

Clipping  the  eyelashes  cannot  be  beneficial  in  any  way,  but 
may  be  decidedly  harmful.  The  lash  is  the  protector  of  the 
eye.  Cutting,  if  it  affected  them  at  all,  would  be  likely  to 
make  them  coarse.     There  is  no  proper  time  to  do  it. 

A  "WEEPING"  EYE 

My  little  boy  of  four  months  has  an  eye  that  "weeps" — that  is 
to  say,  it  is  almost  always  full  of  water,  which  runs  down  his 
cheek  and  seems  to  irritate  the  skin.  What  is  the  cause  of 
this?     Should  it  be  treated? 

The  description  seems  to  correspond  to  an  obstruction  of  the 
tear-duct.  This  can  be  determined  only  by  a  physician.  If 
such  an  obstruction  exists  a  skilful  surgeon  can  remove  it, 
and  thereby  relieve  the  trouble. 

EYE-STRAIN  AS  A  CAUSE  OF  HEADACHE 
How  can  one  recognize  headache  due  to  eye-strain? 

Only  by  a  careful  examination  by  a  competent  oculist  can  it 
be  determined.  But  it  may  be  suspected  whenever  the  head- 
ache is  associated  with  or  follows  the  use  of  the  eyes,  espe- 
cially on  any  kind  of  near  work.  It  is  always  to  be  consid- 
ered when  any  one  suffers  from  persistent  or  frequent 
headaches. 


344  THE  CENTURY  BOOK  FOR  MOTHERS 


PINK-EYE 

How  can  one  tell  pink-eye  from  an  ordinary  cold  in  the  eye? 
Is  pink-eye  contagious? 

Both  terms  being  popular  rather  than  scientific,  it  is  not  easy 
to  make  a  scientific  distinction.  ''Cold  in  the  eye"  we  sup- 
pose to  mean  a  conjunctivitis  (inflammation  of  the  covering 
of  the  ''white  of  eye")  which  is  associated  with  a  "cold," 
and  which  may  be  the  main  manifestation.  As  "colds" 
usually  are  due  to  some  infection,  it  is  probable  that  these 
"colds  in  the  eye"  are  due  to  local  infection— ordinarily,  we 
believe,  to  dust  or  dirt  which  was  infected.  "Pink-eye"  is 
really  a  term  of  veterinary  medicine,  meaning  a  contagious 
disease  of  horses  in  which  the  inflamed  eye  is  a  prominent 
symptom.  Of  recent  years  the  name  has  been  applied,  jo- 
cosely at  first,  to  a  similarly  prevalent  and  doubtless  conta- 
gious disorder  in  human  beings.  There  is  no  real  distinc- 
tion as  we  understand  the  matter,  unless  it  be  the  difference 
of  the  kind  of  infection.  If  the  disease  is  prevalent  it  is 
popularly  called  "pink-eye."  If  it  does  not  spread  it  is  a 
"cold  in  the  eye." 

GRANULAR   EYELIDS 

How  do  granular  eyelids  differ  from  ordinarily  inflamed  eye- 
lids?   What  is  the  treatment? 

The  distinction  is  not  easy  to  put  into  popular  language. 
An  ' '  ordinarily  inflamed  eyelid ' '  probably  means  a  catarrhal 
conjunctivitis,  which  usually  yields  readily  to  skilful  treat- 
ment (the  purulent  conjunctivitis  is  not  now  meant) .  Gran- 
ular conjunctivitis  is  essentially  a  tedious  and  slow-moving 
disease.  It  gets  its  name  from  a  change  in  the  tissues,  chiefly 
inside  the  lower  eyelid,  which  gives  to  the  surface  a  granular 
appearance.  Its  treatment  is  not  domestic.  Usually  pro- 
longed medical  attention  to  the  eye  is  necessary. 


THE  EYES  345 

ASTIGMATISM 

How  can  one  recognize  that  a  child  is  astigmatic,  and  what  can 
be  done  for  the  defect? 

The  defect  called  astigmatism  in  an  eye  or  in  a  lens  is  a 
want  of  perfect  symmetry  in  its  different  meridians,  so  that 
the  rays  passing  into  the  eye  or  lens  are  not  refracted  to  pre- 
cisely the  same  point.  Its  location  and  degree  are  deter- 
mined by  optical  apparatus.  It  may  be  suspected,  at  least, 
by  the  parent  if  the  child  sees  differently  in  different  meri- 
dians. Thus,  if  a  child  sitting  at  a  distance,  say  across  a 
room,  from  a  clock  sees  some  of  the  figures  clearly  and  others 
not,  one  or  both  of  its  eyes  are  probably  astigmatic.  Then 
let  the  child  go  nearer  to  the  clock,  and  observe  if  the  same 
numbers  are  clearly  seen  as  before. 

The  relief  is  the  adjustment  of  glasses  specially  ground  so 
that  they  correct  the  defect  of  the  eye. 


XVIII 
THE  EARS 

EARACHE 

Can  you  give  any  suggestions  as  to  remedies  for  earache  in  chil- 
dren? My  little  boy  of  five  suffers  from  it  very  much,  and  it 
always  comes  on  at  night.  I  use  sweet-oil  and  laudanum, 
warm,  dropped  in  the  ear,  or  soak  a  piece  of  cotton  and  put  it 
in  the  ear;  to  this  I  sometimes  have  to  add  a  hot  poultice  of 
hops,  and  all  this  will  frequently  give  no  relief  for  a  long  time. 
There  does  not  seem  to  be  any  especial  cause  for  these  attacks, 
as  our  physician  has  examined  him  several  times. 

The  occurrence  of  pain  in  the  ear  is  a  pretty  positive  sign 
that  this  organ  is  not  in  perfect  condition,  or  that  some 
part  in  the  immediate  neighborhood  is  diseased ;  thus,  besides 
disease  of  the  ear  itself,  such  pain  may  be  due  to  the  impac- 
tion of  wax  in  the  ear  canal,  or  to  throat  or  nose  trouble. 
Hence  removal  of  the  cause  of  the  pain  by  the  physician 
would  naturally  be  most  advisable.  To  relieve  the  attacks  of 
earache,  when  the  cause  is  unknown,  the  instillation  of  hot 
salt  water  will  be  found  most  efficient.  The  salt  water  should 
be  prepared  by  dissolving  a  teaspoonful  of  table  salt  in  one 
pint  of  water.  This  should  be  used  as  hot  as  can  be  borne 
by  the  sufferer,  and  should  be  poured  into  the  canal  of  the 
ear  by  a  teaspoon  and  then  allowed  to  run  out  again  by  in- 
clining the  head ;  this  may  be  continued  for  half  an  hour  or 
an  hour  until  the  pain  ceases ;  or  the  hot  salt  water  may  be  al- 
lowed to  flow  into  the  ear  from  a  fountain  syringe  held  not 

346 


THE  EARS  347 

higher  than  one  foot  above  the  level  of  the  ear.  After  the 
application  of  heat  in  this  way,  a  large  piece  of  cotton  wad- 
ding should  be  placed  over  the  ear  and  covered  by  a  layer 
of  oiled  silk. 

PARTIAL  DEAFNESS 

I  wish  to  get  advice  in  regard  to  my  little  boy's  partial  deafness. 
Before  he  was  three  years  old  a  severe  cold  would  make  him 
hard  of  hearing,  and  now,  at  five  years  of  age,  the  same  trou- 
ble exists,  and  the  deafness  continues  long  after  all  signs  of 
cold  have  disappeared.  He  has  recently  had  a  bad  cold  and 
earache,  and  he  has  remained  hard  of  hearing  so  long  that  we 
are  anxious  lest  his  trouble  should  become  permanent  and 
past  relief.  He  has  never  had  much  earache  or  any  discharge 
from  his  ear.  Is  there  danger  of  its  becoming  permanent 
deafness?  Can  we  do  anything  to  prevent  this?  He  has  al- 
ways been  a  delicate  child,  having  little  endurance.  His  colds 
always  take  a  croupy  turn,  and  but  for  constant  doctoring 
would  terminate  in  spasmodic  croup. 

There  is  always  danger  of  permanent  deafness  under  such 
circumstances.  Catarrhal  troubles  are  probably  the  com- 
monest cause  of  deafness,  and  they  are  very  active  in  just 
such  delicate  children.  The  child  should  certainly  be  taken 
to  a  physician,  who,  by  advice  as  to  his  general  regimen  and 
by  local  treatment  of  his  throat  and  nose,  may  be  able  to 
prevent  the  advance  of  deafness. 

PROMINENT  EARS 

My  little  boy  is  nine  months  old,  and  his  ears  seem  to  stand  out 
more  and  more  all  the  time.  When  he  was  younger  he  was  a 
frail  child,  and  I  did  not  dare  to  do  anything  about  it ;  but  now 
that  he  is  rugged  can  I  not  correct  this  feature  by  tying  them 
back  in  some  way?     He  has  otherwise  a  handsome  face. 

It  is  probable  that  persistent  bandaging  might  press  the  ears 
flat;  such  treatment  is  successful  in  arresting  the  growth  of 
the  feet  in  certain  classes  of  women  in  China.    But  we  are 


348  THE  CENTURY  BOOK  FOR  MOTHERS 

entirely  certain  that  we  would  not  allow  any  such  thing  to 
be  done  to  any  child  that  was  under  our  care.  The  object 
to  be  gained  is  of  trivial  importance  compared  with  the  per- 
sistent discomfort— running  over  months  or  years— that  must 
be  inflicted  upon  the  child.  When  an  ear  projects  as  the 
result  of  an  inflammation  the  case  is  different,  as  slight  pres- 
sure for  not  a  very  long  while  at  a  time  tends  to  replace  the 
ear  in  its  normal  position.  We  might  add,  however,  that 
inasmuch  as  the  projecting  ears  give  much  distress  to  you,  it 
might  be  proper  to  try  one  of  the  caps  of  tapes  sold  in  the 
shops  for  producing  pressure  on  the  ears.  They  do  not  so 
closely  cover  the  head  as  an  ordinary  cap,  and  are  less  objec- 
tionable. But  even  with  these  we  think  that  evidences  of 
discomfort  should  be  watched  for.  It  is  best  to  use  the 
tape  cap  only  at  night,  or  when  the  child  is  by  itself.  It 
annoys  the  child  to  be  made  noticeable,  and  the  treatment 
itself  may  make  him  painfully  conscious  of  his  ears. 

TAMPERING  WITH   LARGE  EARS 

"Little  pitchers  have  big  ears."  Unfortunately  for  my  dear 
little  girl  of  seven  years,  hers  are  large,  physically  and  meta- 
phorically. They  stand  out  like  handles.  This  peculiarity  is 
not  hereditary,  and  I  am  anxious  to  correct  it.  Can  you  help 
me  with  your  advice?  When  I  tie  ribbons  over  them  to  press 
gently  she  complains  of  soreness  in  a  short  while.  Am  I  in 
danger  of  doing  an  injury  to  the  internal  organ  by  pressing 
externally?  I  am  anxious  to  free  her  from  the  misfortune  of 
prominent  ears  in  later  life. 

We  can  help  you  with  advice,  and  it  is  to  let  the  ears  alone. 
Any  pressure  you  make  is  far  more  likely  to  irritate  the 
ears  and  thereby  increase  their  want  of  beauty  than  to  im- 
prove their  appearance.  The  ear,  for  some  reason  or  other, 
seems  to  be  considered  a  part  of  the  body  that  can  be  trifled 
with.  Very  few  persons  would  think  of  meddling  with  a 
nose  that  was  not  shapely,  or  with  lips  that  were  ill-looking, 
but  the  ear  is  practised  upon  in  various  ways.     It  is  hard  to 


THE  EARS  349 

say  why  the  wearing  of  rings  in  the  ears  should  have  sur- 
vived the  kindred  mutilation  of  the  nose  and  lips.  Time 
may  improve  the  set  of  the  ears,  and,  at  all  events,  the  ar- 
rangement of  the  hair  will  improve  their  appearance  far 
more  than  anything  you  can  do  to  them. 

HARDENING  OF  EAR-WAX 

What  causes  wax  to  harden  in  the  ear,  and  what  is  the  remedy? 
My  little  girl,  aged  three  and  one  half  years,  is  bothered  with 
wax  in  both  ears. 

There  are  several  known  causes.  The  chief  are  over-forma- 
tion of  the  ear-wax  and  a  changed  composition  of  it,  due 
usually  to  inflammations  of  the  ear.  The  only  preventive 
we  know  of  is  to  keep  the  ear  and  throat  in  a  healthy  condi- 
tion. The  removal  of  an  accumulation  is  accomplished  by 
mechanical  means.  Probably,  for  domestic  practice,  the  saf- 
est way  is  to  soften  the  mass  by  keeping  a  little  sweet-oil  in 
the  ear  for  a  day  or  two,  and  then  gently  syringing  out  the 
ear  with  lukewarm  water. 

CAUSE  AND    PREVENTION   OF  EAR  TROUBLE 

My  little  girl  of  five  years  has  had  two  gatherings  in  her  ears, 
both  of  which  I  treated,  according  to  the  physician's  instruc- 
tions, by  gentle  syringing  of  warm  water  with  boracic  acid 
dissolved  in  it. 

Is  there  any  way  to  prevent  these  attacks,  except  by  precau- 
tions against  taking  cold?  Is  there  danger  of  loss  of  hearing, 
and,  if  so,  can  it  in  any  way  be  prevented? 

These  attacks  nearly  always  come  from  the  spread  of  an  in- 
flammatory process  (probably  bacterial)  from  the  throat. 
Whatever  measures,  hygienic  or  medicinal,  prevent  throat 
trouble  prevent  also  ear  inflammations. 

There  is  danger  of  deafness  if,  as  we  assume,  the  trouble 
is  in  the  middle  ear.     The  treatment  of  middle-ear  trouble 


350  THE  CENTURY  BOOK  FOR  MOTHERS 

must  lie  with  the  physician.  Puncture  of  the  ear-drum  is 
often  necessary,  and  is  of  great  value  in  limiting  the  mis- 
chief threatening. 

SIGNIFICANCE  OF   A   RUNNING   EAR 
Is  a  running  ear  always  a  sign  of  some  chronic  trouble? 

No,  for  the  running  may  be  only  recent  and  occurring  for 
the  first  time.  But  a  frequent  or  a  recurring  running  of  the 
ear  is  presumptive  evidence  of  a  chronic  trouble. 


XIX 
THE   HAIR  AND  SCALP 

STRENGTHENING  THIN   HAIR 

I  have  reason  to  believe  that  my  little  girl,  now  three  and  a  half 
months  old,  has  inherited  a  weak  growth  of  hair.  Can  I  do 
anything  now,  or  a  little  later,  to  strengthen  the  hair  and 
roots  ? 

It  is  too  soon  to  be  anxious  about  the  child's  growth  of  hair. 
She  may  never  have  an  abundant  growth,  but  its  present 
thinness  is  no  evidence  to  that  effect.  The  greatest  variabil- 
ity exists  in  regard  to  the  time  when  the  hair  becomes  thick. 
We  have  seen  children  at  birth  whose  hair  was  so  abundant 
as  to  need  a  regular  toilet,  and  who  at  three  months  of  age 
looked  as  if  they  were  wearing  wigs.  On  the  other  hand,  we 
know  adults  whose  hair  is  very  thick  who  were  practically 
bald  up  to  two  years  of  age. 

Nevertheless,  as  you  are  anxious,  we  may  give  you  some 
hints  as  to  what  to  do  and  what  not  to  do.  If  the  hair  had 
fallen  out  from  an  illness  or  from  a  disease  of  the  scalp,  some 
medication  would  be  advisable;  but  in  such  a  case  as  you 
describe  it  certainly  is  not.  What  you  have  to  do  is  to  give 
the  scalp  the  best  possible  chance  to  grow  the  hair.  See  that 
the  scalp  is  always  clean— that  is,  free  from  dandruff,  from 
the  flaky  deposit  often  met  with  (seborrha3a).  See  also  that 
the  head  is  not  heated  nor  unnecessarily  covered.  But  in 
giving  it  this  attention  do  not  irritate  it.  Do  not  rub  it 
roughly  nor  use  much  soap  upon  it.  Wash  it  gently,  dry  it 
gently.     Remove  any  deposit  upon  it  by  very  gentle  friction 

351 


352       THE  CENTURY  BOOK  FOR  MOTHERS 

with  a  finger  anointed  with  vaseline  or  any  perfectly  bland 
oil.  Use  a  very  soft  brush  in  arranging  the  hair  and  avoid 
combs  altogether.  Adhere  to  the  same  gentle  precautions 
after  the  child  is  older,  and  you  will  have  done,  in  our  judg- 
ment, the  best  that  can  be  done. 

WASHING   THE  SCALP 

When  a  child's  scalp  seems  perfectly  healthy  and  there  is  a  good 
crop  of  hair,  how  frequently  should  the  entire  head  be  washed 
to  insure  a  continuance  of  health?  Also,  with  a  predisposi- 
tion to  catarrh  of  the  head,  is  there  danger  in  washing,  if  the 
hair  is  thoroughly  rubbed  till  it  feels  dry? 

Wash  the  head  often  enough  to  secure  cleanliness  of  the  scalp, 
which  may  be  determined  by  frequent  careful  examination 
for  dandruff,  etc.  Instances  occur  where  the  "catching 
cold"  seems  to  be  directly  dependent  on  the  washing  of  the 
head ;  but  as  a  rule  it  is  safe  to  wash  the  head,  if  the  washing 
is  done  in  a  warm  room  and  the  hair  is  thoroughly  dried 
directly  afterward. 

THE  USE  OF  SOAP  ON  THE  HEAD 

My  three-months-old  baby's  head  is  always  white  and  clean,  and 
I.  have  washed  it  with  soap  every  morning,  using  a  little  vase- 
line once  a  week.  I  notice  that  for  a  few  days  after  using 
the  vaseline  the  scalp  is  just  as  clear  as  his  little  face,  and 
then  the  skin  begins  to  look  dry.  Does  the  use  of  soap  tend 
to  dry  the  natural  oil  of  the  hair? 

For  some  weeks  after  birth  the  "lathering"  has  a  good  effect 
in  dislodging  the  secretion  of  the  scalp,  which  is  then  often 
excessive.  After  a  while  it  is  not  necessary  to  use  soap  every 
day  in  the  head-washing,  two  or  three  times  a  week  usually 
being  enough ;  but  if  any  scurf  begins  to  form  the  daily  use 
of  soap  can  be  resumed.  First,  however,  try  if  vaseline  will 
not  remove  the  scurf,  as  it  is  less  irritating  than  some  soaps. 


THE  HAIR  AND  SCALP  353 


TAMPERING  WITH  THE  COLOR   OF  THE  HAIR 

I  should  be  greatly  obliged  if  I  could  get  information  as  to  how 
to  make  a  baby's  hair  gradually  darker.  My  little  boy's  eye- 
lashes being  very  light,  I  fear  his  hair  will  remain  about  the 
same. 

We  have  no  advice  to  offer  except  that  you  should  carefully 
abstain  from  all  attempts  to  change  the  natural  color  of  your 
child's  hair.  No  attempts  on  your  part  will  effect  anything 
but  damage  to  the  hair.  There  is  a  very  strong  tendency  for 
children's  hair  to  darken  after  two  or  three  years  of  age. 
Most  mothers  would  rejoice  in  the  blonde  hair  of  a  baby. 


MILK-CRUST 
Does  milk-crust  differ  from  eczema,  and  what  can  be  done  for  it  ? 

Milk-crust  is  a  name  applied  to  the  eczema  of  the  scalp  and 
face  of  young  children.  Its  treatment  is  rather  too  difficult 
for  domestic  practice.  The  essentials  of  the  treatment  are  the 
regulating  of  the  nutrition  of  the  child  (if  artificially  fed, 
usually  its  dietary  needs  supervision)  ;  the  soaking  off  of  the 
crusts  and  keeping  the  scalp  clean;  and  the  application  of 
soothing  remedies,  usually  in  the  form  of  ointments. 


THE  BELIEF  THAT  LONG   HAIR   IS  WEAKENING 

My  little  girl  is  just  four  years  old,  and  has  an  unusually  long 
and  heavy  head  of  hair  for  her  age.  She  is  not  a  very  strong 
child,  and  several  friends  have  advised  me  to  cut  her  hair 
off,  but  I  dislike  the  idea  very  much,  as  her  hair  curls  in 
loose  ringlets,  and  it  is  a  great  ornament  to  her.  When  it  is 
dampened  a  little  and  brushed  out  straight  it  reaches  almost 
to  her  waist.  If  I  thought  her  strength  was  going  to  her  hair 
I  would  not  sacrifice  her  health,  but  nothing  else  would  induce 
me  to  cut  it.  Will  you  tell  me  if  you  think  I  should  cut  it 
off,  or  would  cutting  it  partly  be  of  any  benefit? 
23 


354  THE  CENTURY  BOOK  FOR  MOTHERS 

She  does  not  complain  of  headache,  but  suffers  somewhat  from 
stomach  disorder,  as  her  tongue  is  often  quite  white,  especially 
in  the  morning. 

The  belief  that  long  hair  is  weakening  is  very  common,  but 
we  know  of  no  real  ground  for  it.  So  far  as  we  have  been 
able  to  discover,  it  may,  like  any  excessive  growth  of  body, 
be  weakening  if  proper  nutrition  is  not  kept  up,  just  as  we 
hear  the  expression,  "The  child  has  outgrown  its  strength." 
In  such  cases  the  indication  is  not  to  try  to  stop  the  growth, 
but  to  spare  the  child  taxing  occupations,  and  see  to  its  nu- 
trition, until  the  balance  is  restored.  If  the  growth  of  hair 
were  really  in  any  case  excessive,  we  should  deal  with  it  on 
that  plan.  But  to  cut  it  off  will  not  help.  It  does  not  retard 
growth.  It  is  thought  to  stimulate  it,  rather.  There  are  rea- 
sons why  we  sometimes  recommend  cutting  long  hair.  Thus : 
Suppose  a  child  has  reached  an  age  of  great  activity,  and  is 
always  romping,  climbing,  etc. ;  a  long  wad  of  hair  on  the  back 
of  the  neck  acts  as  a  muffler,  making  the  neck  perspire;  the 
next  moment  it  is  blown  aside  or  falls  aside  in  the  child's 
activity,  and  the  neck  is  chilled.  We  do  believe  that,  under 
these  conditions,  especially  in  an  active  boy,  the  alternate 
heating  and  chilling  of  the  neck  and  ears  does  tend  to  aggra- 
vate or  cause  catarrhal  conditions  of  the  nose,  throat,  and 
ears.  Your  own  child  seems  to  need  judicious  care  of  her 
stomach  from  a  physician,  rather  than  the  barber's  atten- 
tions. 


XX 

THE  FEET 

INCIPIENT  CORNS 

I  have  always  been  very  careful  about  my  little  girl's  shoes,  that 
they  should  neither  pinch  nor  rub,  and  she  wore  moccasins 
for  a  long  time.  She  is  now  three  years  of  age,  and  on  the 
little  toe  of  each  foot  there  is  a  decided  corn,  the  size  of  a 
pin-head.  Is  there  any  way  in  which  I  can  cure  them,  so  that 
she  need  not  be  troubled  with  them  always? 

There  must  be  some  mistake.  Corns  never  come  unless  there 
is  pressure  or  friction,  and  nothing  can  permanently  cure  a 
corn  so  long  as  the  pressure  or  friction  continues.  A  shoe 
may  be  very  large  and  yet  produce  corns  because  its  shape 
is  not  right.  We  have  seen  many  moccasins  of  such  faulty 
shape  that  they  could  not  fail  to  produce  irritation. 

First  of  all,  reconsider  the  question  of  shoeing.  See  if  the 
shoe  holds  neatly  to  the  ankle  and  hinder  part  of  the  foot ; 
see  next  that  there  is  plenty  of  room  for  the  toes  not  only  to 
go  in  but  to  expand  and  play  as  the  foot  is  moved.  Often  it 
is  requisite  to  get  shoes  two  or  three  sizes  too  long  in  order  to 
secure  the  necessary  width.  In  the  fitting  of  the  shoe  lies  the 
whole  matter. 

The  relief  of  an  already  acquired  corn  may  be  accom- 
plished best  by  first  paring,  then  applying  to  the  surface  a 
solution  of  salicylic  acid,  say  one  part  to  eight  of  water,  and 
after  a  day  or  two  scraping  aw^ay  any  part  that  has  been 

355 


356  THE   CENTURY  BOOK  FOR  MOTHERS 

softened  by  the  application,  and  repeating  this  until  the  corn 
is  removed. 

The  corn,  too,  may  be  protected  from  friction  by  means 
of  a  plaster  with  a  hole  of  suitable  size  in  it,  the  plaster  being 
so  applied  that  the  hole  falls  immediately  over  the  corn. 
For  children's  feet  these  plasters  are  best  made  extempo- 
raneously from  several  layers  of  the  ordinary  adhesive  plas- 
ter to  be  found  at  drug-stores. 

DISTORTED   FEET 

What  is  the  remedy  as  well  as  prevention  for  misshapen  feet? 

Why,  if  the  baby  foot  is  shaped  rightly  (the  toes  slightly  spread, 
and  the  weight  apparently  evenly  divided  over  the  sole  of  the 
foot  and  on  the  bottom  of  each  toe),  when  shoes  have  been 
worn  for  a  few  years,  does  the  shape  of  the  foot  change  and 
the  ends  of  the  toes  turn  downward,  the  joints  pointing  up- 
ward? This  is  the  way  the  feet  of  my  oldest  boy,  aged  six, 
and  my  girl,  aged  three,  have  changed,  although  they  have  al- 
ways worn  shoes  at  least  one  fourth  of  an  inch  longer  than 
their  feet.     I  cannot  but  feel  that  the  trouble  is  in  the  width. 

Is  it  lack  of  sufficient  length  or  width  that  is  to  blame  for  the 
immense  joint,  that  sometimes  inflames,  on  the  inside  of  the 
foot? 

The  remedy  lies  chiefly  in  the  wearing  of  the  same  kind  of 
shoes  that  would  have  prevented  the  distortion  in  the  first 
instance.  But  after  a  certain  degree  of  displacement  and 
rigidity  has  occurred  other  management  is  necessary.  The 
subject  is  too  wide  to  be  treated  of  in  the  space  at  our  com- 
mand. 

We  are  not  sure  that  we  understand  correctly  what  is  in- 
tended. There  is  a  crumpling  up  of  the  toes  and  the  thrust- 
ing of  one  under  another,  due  to  the  shoes  being  short  or 
too  narrow  and  pointed ;  this  change  is  a  familiar  one.  But 
we  think  you  mean  a  change  which  is  natural  and  proper, 
within  limits— namely,  that  the  habit  of  springing  upon  the 
toes  in  walking  gives  to  them,  particularly  the  outer  ones,  a 


THE  FEET  357 

slight  curve  upward,  with  some  enlargement  of  the  bulbous 
extremity.  You  can  reexamine  the  children's  feet  and  see 
which  change  you  have  to  deal  with.  If  the  toes  are  crowded 
together  and  the  imprint  of  one  is  left  upon  another,  the 
shoes  have  done  at  least  a  part  of  the  distorting. 

Insufficient  length  may  have  some  share  in  distorting  the 
joint.  But  the  deformity  is  created  thus :  A  shoe,  the  inner 
margin  of  the  sole  of  which  turns  outward— as  is  usual  in 
shop-shoes — at  the  toe- joint,  crowds  the  great  toe  toward  its 
fellows;  pressure  is  made  upon  parts  of  the  joint  not  well 
prepared  for  it,  then  the  narrow  upper  chafes  and  sets  up  an 
inflammatory  process,  which  ultimately  results  in  chronic 
thickening  of  the  soft  parts,  and  even  of  the  bone.  These 
distortions  sometimes  are  so  extreme  as  to  render  the  cutting 
out  of  the  joint  necessary. 

INGROWING  NAILS 

Can  you  tell  me  of  some  cure  for  ingrowing  toe-nails,  and  also 
what  is  liable  to  cause  them?  It  cannot  be  tight  shoes  in  the 
case  of  my  two-year-old,  as  I  have  always  been  especially  care- 
ful to  have  his  shoes  roomy  and  comfortable.  He  seems  to 
suffer  from  them,  and  I  feel  anxious  to  help  him  by  some  sim- 
ple means,  if  possible. 

The  mischief  done  by  shoes  is  less  from  small  size  than  from 
faulty  shape.  It  is,  of  course,  possible  that  an  ingrowing 
nail  may  not  come  from  tight  shoes,  but  certainly  ninety- 
nine  cases  in  a  hundred  are  due  to  the  shoe  pressing  the  toes 
together.  The  great  toe  most  frequently  suffers ;  it  is  crowded 
against  its  neighbor,  the  flesh  is  pushed  up  and  laps  over  the 
nail,  and  the  margin  of  the  nail,  being  crowded  toward  the 
center  of  the  toe,  turns  downward  and  so  grows.  Sometimes, 
however,  there  is  no  fault  in  the  nail  itself,  simply  in  the 
crowding  up  of  the  flesh,  which  thus  becomes  irritated  under 
the  pressure.  If  a  foot  has  never  been  crowded,  the  sides  of 
the  toes  are  rounded  as  at  birth,  and,  like  the  fingers,  remain 
so  through  life.     Actually,  it  is  rare  to  see  a  foot  some  of  the 


358  THE  CENTUEY  BOOK  FOR  MOTHERS 

toes  of  which  have  not  left  their  imprint  upon  their  fellows 
from  this  lateral  pressure.  Keep  the  toe  that  is  in  trouble 
separated  from  its  neighbor  by  a  folded  piece  of  linen  put 
between  them— slightly  oiled  if  there  is  sign  of  friction 
against  the  linen— and  the  trouble  will  probably  be  relieved. 
If  necessary,  the  down- growing  corners  of  the  nails  may  be 
raised  by  the  thrusting  under  of  a  pledget  of  soft  cotton. 
In  paring  the  nails  do  not  cut  off  the  corners,  but  cut  the 
nail  square  across.  These  corners  should  protect  the  flesh; 
if  cut  off  the  tendency  to  burrow  is  increased. 


XXI 
HYGIENE  AND  SANITATION 


THE  OBJECTIONS  TO  VACCINATION;  SUPPOSED  FAILURE 

OF    VACCINATION  TO   PROTECT;  THE  PROPER 

AGE  FOR  VACCINATION 

There  have  recently  occurred  in  our  community  several  cases  of 
small-pox,  and  the  health  board  has  ordered  that  all  school- 
children be  vaccinated,  and  advises  parents  of  even  younger 
children  than  those  of  school  age  to  have  them  revaccinated. 
This  seems  to  many  of  us  a  very  unnecessary  and  harsh  mea- 
sure, as  not  a  few  intelligent  persons  here  and  elsewhere  are 
quite  skeptical  about  the  value  of  vaccination,  particularly  in 
the  case  of  very  young  children.  Is  it  not  true  that  children 
have  often  been  inoculated  with  scrofula,  consumption,  and 
other  diseases  through  the  vaccine  virus?  And  how  is  it  that 
vaccination  so  often  does  not  "take"?  Is  not  a  child  of  less 
than  two  months  too  young  to  be  vaccinated? 

This  letter  again  calls  attention  to  the  singular  prejudice 
against  vaccination  still  surviving  among  otherv^ise  v^ell-in- 
formed  persons.  It  is  difficult  to  account  for  this  on  any 
other  theory  than  that  the  almost  complete  immunity  from 
small-pox  which  the  civilized  world  of  to-day  enjoys  has 
caused  it  to  forget  what  were  the  ravages  of  that  plague  a 
hundred  years  ago.  The  objections  to  vaccination  have  been 
often  urged,  and  again  and  again  met.  An  apparent  failure 
of  vaccination  to  protect  is  invariably  due  to  neglect  of  sec- 
ondary operations;  and  as  to  the  often  expressed  dread  of 
the  introduction  of  scrofula  and  consumption  into  the  system 
through  vaccination,  there  is  practically  no  evidence  whatever 

359 


360       THE  CENTURY  BOOK  FOR  MOTHERS 

in  support  of  the  assumption,  when  proper  virus  was  used.  Of 
course,  the  virus  must  be  properly  chosen  and  applied  by  a 
physician,  for  in  unskilful  hands  it  certainly  may  work  mis- 
chief. Good  virus  well  applied  is  practically  always  safe. 
The  mischiefs  attributed  to  vaccination  are  almost  always 
due  to  something  else.  Generally  speaking,  a  child  is  never 
too  young  to  be  vaccinated  if  there  be  danger  of  an  exposure 
to  small-pox,  and  it  is  better  that  the  operation  be  performed 
before  the  teething  period  begins.  When  the  child  is  six  weeks 
old  it  is  time  to  consider  the  question  seriously,  and  the 
vaccination  should  not  be  delayed  unless  the  physician  sees 
reason  for  postponing  it. 


THE   DISADVANTAGE  OF   POSTPONING  VACCINATION 

My  husband  and  I  both  have  a  horror  of  vaccination,  and,  liv- 
ing in  the  country,  have  never  had  it  performed.  If  it  is  to 
be  done,  will  it  be  the  worse  the  longer  we  put  it  off,  and  what 
time  of  year  is  best  for  the  operation?  Our  baby  is  fourteen 
months  old. 

The  disadvantage  of  postponing  vaccination  (aside  from  the 
special  risk  of  infection  taken,  which  is  diminished  just  in 
proportion  as  your  neighbors  live  up  to  their  duty  in  this 
matter)  is  chiefly  this:  The  older  the  child  the  more  active 
it  is,  and  the  more  likely  to  injure  and  irritate  the  point  of 
vaccination  and  to  infect  it  with  some  other  matter  (from 
finger-nails  or  elsewhere),  and  so  change  a  perfectly  harm- 
less affair  into  a  possibly  serious  one.  As  to  your  ' '  horror, ' ' 
we  can  say  nothing,  as  sentiments  cannot  be  argued  about. 
But  we  can  say  in  all  seriousness  that  the  arguments  against 
doing  things  on  Friday  because  it  is  unlucky  are  much  more 
convincing  than  the  arguments  urged  against  vaccination. 
To  our  mind,  neglect  of  vaccination,  unless  a  child  have  some 
illness  or  other  disability,  is  distinctly  wrong.  There  is  no 
particular  time  which  is  preferable  to  have  it  done,  but  as 
the  skin  is  more  likely  to  be  irritated  in  very  hot  and  very 


HYGIENE  AND  SANITATION  361 

cold  weather,  we  should  perhaps  elect  the  milder  seasons ;  but 
the  time  to  have  it  done  is  when  your  physician  has  good 
fresh  virus  on  hand. 

Whether  for  the  reasons  given  above  or  some  other,  it  is  a 
fact  that  young  babies  are  less  disturbed  by  vaccination  than 
older  ones. 


THE  DESIRABILITY  OF  KEEPING  WATER  ON  THE  STOVE 

I  would  like  to  ask  your  opinion  as  to  the  desirability  of  keeping 
a  vessel  of  water  on  the  nursery  stove.  Formerly  I  thought  it 
was  the  proper  thing  to  do,  to  keep  the  air  moist.  Then  I 
was  told  that  the  steam  was  considered  objectionable,  induc- 
ing throat  troubles.     Which  theory  is  correct? 

It  is  hard  to  prove  anything  as  regards  the  effect  of  a  vessel 
of  water  or  its  absence,  but  our  own  notion,  which  we  offer 
for  what  it  is  worth,  is  this :  A  vessel  on  a  stove  hot  enough 
to  generate  steam  is  not  desirable  except  as  a  remedy  under 
certain  circumstances,  as,  for  instance,  in  croup.  But  if  a 
room  is  heated  in  such  a  way  as  to  make  its  air  too  dry,  a 
broad  vessel  of  water  standing  in  the  room  may  give  off 
enough  vapor  to  mitigate  this  dryness.  The  vessel  may  be 
near  the  stove,  but  should  not  be  so  placed  as  to  generate  a 
visible  steam. 

PLANTS   IN  THE  BEDROOM 

I  wish  to  ask  your  advice  about  having  plants  in  a  bedroom.  I 
am  so  situated  that  my  bedroom  must  also  be  my  nursery, 
and  I  should  like  to  make  it  as  attractive  as  possible.  A  bow- 
window  affords  plenty  of  sunshine  from  seven  o'clock  a.m. 
until  five  o'clock  p.m.  Is  it  unhealthy  to  have  plants  growing 
in  a  bedroom? 

Plants  are  not  usually  injurious  in  a  room  during  the  day- 
time. When  there  is  sunlight  the  plants  absorb  carbonic  acid 
and  appropriate  its  carbon  and  set  free  a  certain  amount  of 


362  THE  CENTURY  BOOK  FOR  MOTHERS 

oxygen.  This  process  is  not  harmful,  but  rather  the  reverse, 
to  animal  life.  The  only  harm  that  need  be  considered  is 
that  possibly  arising  from  any  considerable  quantity  of  damp 
earth  in  the  room,  but  this  is  probably  very  slight.  But  with 
the  coming  of  darkness  this  process  of  absorption  of  carbonic 
acid  ceases,  and  a  certain  amount  of  the  gas  is  given  off ;  just 
how  much,  of  course,  varies  with  the  quantity  and  kind  of 
plants  in  your  greenery.  The  effect  is  in  kind,  if  not  in 
degree,  very  much  the  same  as  that  of  having  another  person 
sleeping  in  the  room.  If  you  can  arrange  your  plants  upon 
a  stand  with  casters  that  can  be  rolled  out  of  the  room  before 
sundown  and  brought  back  in  the  morning,  the  plants  will 
probably  be  harmless;  otherwise  they  are  better  away. 

PROPER  AND   IMPROPER    FILTERS 

Will  you  please  tell  me  what  kind  of  a  filter  is  best  to  use  for 
filtering  water?  I  have  read  so  much  both  for  and  against 
filters  that  I  had  come  to  the  conclusion  that  there  was  about 
as  much  danger  in  using  the  ordinary  filter  as  in  giving  the 
water  unfiltered,  but  after  reading  an  article  on  "Intestinal 
Worms"  I  would  like  to  have  your  opinion  on  the  subject. 

If  you  care  to  buy  one  of  the  well-known  ''Pasteur"  filters, 
which  are  rather  costly,  or  a  similar  one,  and  will  keep  it  in 
order,  you  will  have,  we  think,  a  safe  article.  Ordinary  fil- 
ters, we  believe,  do  more  harm  than  good.  They  strain  out 
coarse  dirt,  but  they  are  admirable  culture  places  for  all  the 
micro-organisms  found  in  water.  Our  favorite  device  for 
cleansing  water  is  to  have  a  number  of  bags  made  of  stout 
flannel  with  strings  at  their  mouths.  One  of  these  is  tied 
over  the  opening  of  the  faucet  and  the  water  turned  on  gen- 
tly; this  strains  out  coarse  (visible)  dirt.  No  bag  should  be 
used  longer  than  one  day,  and  if  the  water  is  unusually 
dirty  the  bags  may  be  changed  several  times  daily.  They 
should  be  thoroughly  boiled  before  being  used  again.  If 
there  is  any  reason  to  suppose  that  the  water  is  unwhole- 
some, it  should  be  boiled  before  using.     It  may  be  kept  in 


HYGIENE  AND  SANITATION  363 

stoppered  bottles  or  jugs,  and  if  desired  for  drinking  a  bottle 
may  be  easily  cooled  in  the  refrigerator. 


SULPHUR    FOR   DISINFECTION 

We  have  had  one  mild  case  of  scarlet  fever  in  our  family,  and 
our  doctor  has  depended  for  disinfectants  entirely  upon  fresh 
air,  sunshine,  and  an  open  fire.  The  patient  has  been  isolated 
in  a  bare-floored  room  for  four  weeks  and  will  be  longer,  the 
other  children  being  in  perfect  health  to-day.  As  to  fumiga- 
tion by  sulphur,  the  doctor  says  that  the  "Sulphur  Congress" 
has  just  decided  that  the  fumes  of  sulphur  have  no  effect  on 
disease  germs.  If  this  is  so,  why  is  not  this  fact  proclaimed? 
Is  it  because,  as  our  doctor  says,  "It  is  better  for  some  people 
to  keep  their  faith  in  sulphur,  as  they  cannot  be  induced  to 
open  the  windows  unless  there  is  a  very  strong  odor  to  dis- 
pose of"? 

We  are  well  aware  that  sulphur  fumigations,  if  poorly  car- 
ried out,  and  perhaps  as  usually  done,  are  useless.  But  while 
the  debate  as  to  the  value  of  sulphur  fumes  has  gone  on,  we 
have  not  been  convinced  that,  if  properly  used,  they  are 
useless.  They  must  be  used  with  moisture,  hence  we  usually 
make  steam  at  the  same  time  with  the  vapor ;  and  they  must 
be  made  to  penetrate  every  portion  of  the  apartment  to  be 
disinfected.  It  is  easy  to  admit  that  more  powerful  disin- 
fectants exist,  but  the  use  of  most  of  them  is  generally  not 
practicable.  At  the  present  time  formaline  lamps  of  moder- 
ate cost  and  considerable  efficiency  are  sold  in  drug-shops  and 
similar  places.  These  are  efficient.  It  may  be  also  admitted 
that  one  living  in  a  country  village  may  rely  more  upon  air 
and  sunshine  than  a  city  dweller,  because  the  former  gets 
more  of  these  natural  purifiers,  and  because  he  endangers 
fewer  persons  by  this  method  of  disinfection  than  would 
the  latter.  In  this  particular  disease,  moreover,  the  fact 
that  many  escape  contagion  under  all  circumstances  is 
helpful  to  the  success  of  whatever  plan  of  disinfection  be 
adopted. 


364  THE  CENTURY  BOOK  FOR  MOTHERS 


DISINFECTANTS 

Will  you  tell  us  of  an  article  or  articles  to  use  as  antiseptics 
and  deodorants  for  a  cesspool  whose  funnel-shaped  opening  is 
near  the  house?  Dish-water  and  such  slops  only  are  emptied 
into  it,  and  it  discharges  into  a  rapidly  flowing  creek  about 
thirty  feet  distant. 

One  of  the  cheapest  articles  is  sulphate  of  iron  (copperas), 
which  may  be  thrown  into  the  cesspool  if  it  contains  standing 
liquid ;  if  not,  dissolve  the  copperas  in  a  pail  of  water.  Com- 
mon rock-salt  used  abundantly  is  useful,  and  more  powerful 
than  either  is  a  mixture  of  salt  and  sulphate  of  zinc— say 
three  parts  of  the  former  to  four  of  the  latter— dissolved  in 
water  and  poured  into  the  cesspool. 


GROUND  AIR   FROM  EXCAVATIONS ;  QUININE  AS  A 
PREVENTIVE  OF   FEVER  AND  AGUE 

A  serious  defect  in  our  drain  renders  it  necessary  for  us  to  lay 
new  pipes  outside  the  house.  This  of  course  means  the  turn- 
ing up  of  impure  earth.  Will  you  suggest  some  safeguard  for 
children  who,  while  playing  outside,  are  somewhat  near  the 
trench?  The  work  may  take  a  week  or  more.  Would  you 
advise  quinine  to  be  given  during  that  time? 

Chlorinated  lime  in  powder,  or  a  copperas  solution,  sprinkled 
over  the  earth  is  probably  as  good  as  anything.  If  in  a  dis- 
trict where  fever  and  ague  often  appears,  the  quinine  may 
be  given  in  moderate  doses. 


TEMPERATURE  OF  THE  NURSERY  AND  THE  BEDROOM 
What  is  the  proper  temperature  of  the  night  and  day  nurseries? 

Day  nursery,  65°  to  68°,  or,  at  most,  70°  F.  Some  strong 
children  can  get  on  at  a  lower  temperature  than  60°,  but  the 
figures  set  are  the  best  average.     The  night  temperature  may 


HYGIENE  AND   SANITATION  365 

be  cooler,  but  not  very  much,  as  the  child  is  liable  to  toss 
its  bed-clothes  off. 

THE  GAS-STOVE  IN  THE  NURSERY 

My  nursery  is  over  the  kitchen,  but  cannot  be  heated  from  it. 
There  is  no  room  above.  We  rent  the  house.  I  put  in  last 
autumn  a  small  stove  to  be  open  or  shut,  and  burn  either  wood 
or  coal,  but  it  sent  out  so  much  gas  and  smoke  that,  it  being  a 
warm  season,  we  seldom  used  it.  The  afternoons  are  not  cold 
enough  to  require  a  fire  in  the  room,  but  I  must  have  some 
way  of  heating  it  before  the  baby  comes  from  her  bedroom  in 
the  morning.  The  chief  difficulty  with  the  present  stove  is 
that  the  hole  into  the  chimney  is  rather  low,  and  the  draft  is 
not  good,  especially  when  the  kitchen  stove  is  first  lighted. 

Could  I  use  a  gas-stove,  or  anything  else  that  would  not  require 
connection  with  that  bad  chimney?  Please  tell  me  what  would 
be  the  best  and,  incidentally,  the  least  expensive  method  of 
heating  this  room. 

A  gas-stove  of  the  ordinary  kind  is  always  very  objection- 
able, because  the  products  of  combustion  are  left  in  the  room, 
and  the  air  is  more  vitiated  by  one,  even  if  small,  than  it 
would  be  by  the  presence  of  many  persons.  If  you  can  find 
any  form  of  good  gas-heater  with  an  escape-flue  for  fumes  it 
might  do.  The  chimney  certainly  ought  to  have  a  separate 
flue  for  each  room.  Your  nursery  stove,  in  a  properly  con- 
structed chimney,  ought  to  draw  all  the  better  if  the  kitchen 
fire  has  already  warmed  the  chimney.  If  you  cannot  find  a 
stove  that  will  draw  properly,  we  think  the  best  plan  would 
be  to  carry  the  pipe  of  the  kitchen  stove  through  the  ceiling 
and  into  the  chimney  in  the  nursery.  In  a  mild  climate 
sufficient  heat  would  probably  be  given  off  from  the  heated 
stovepipe  for  the  needs  of  the  nursery. 

HOW  LONG  DO   DIPHTHERIA  GERMS   LINGER? 

I  have  been  considerably  troubled  about  my  duty  toward  an  ac- 
quaintance who  recently  moved  into  a  house  near  mine,  where. 


366       THE  CENTURY  BOOK  FOR  MOTHERS 

five  months  ago,  there  were  two  bad  cases  of  diphtheria.  The 
children  were  desperately  ill,  and  one  of  them,  as  I  heard  the 
physician  himself  say,  was  saved  by  antitoxin  only  at  the  last 
moment. 
I  believe  the  house  was  thoroughly  disinfected,  but,  nevertheless, 
it  was  quite  a  shock  to  me  when  I  learned  that  the  lady  I 
speak  of  had  moved  into  the  house  with  her  two  sweet  little 
children.  I  try  to  put  myself  in  her  place,  and  know  that  I 
should  have  been  so  grateful  if  some  conscientious  neighbor 
had  warned  me  of  the  possible  danger,  even  if  the  landlord  had 
not  thought  it  his  duty  to  do  so.  To  speak  of  it  now  that  she 
has  moved  into  the  house  may  create  unnecessary  alarm,  and 
yet,  perhaps,  it  is  my  duty,  after  all,  to  let  her  know  the  facts. 
In  any  case,  as  a  similar  dilemma  may  arise  elsewhere,  I  shall 
be  glad  of  your  opinion  as  to  whether  diphtheria  germs  may 
remain  active  in  a  house  five  months  after  the  outbreak  of  the 
disease,  and  how  rigorous  a  disinfection  will  secure  absolute 
immunity  from  diphtheria,  at  least  as  far  as  the  original  cause 
of  the  outbreak  is  concerned. 

We  cannot  answer  the  question  in  a  way  to  help  yon  decide 
your  present  duty,  although  we  know  that  the  Klebs-Loeffler 
bacillus  remains  a  long  time  in  the  throats  of  those  who  have 
had  diphtheria,  without  known  reinfection,  and  that  it  is 
found  in  the  throats  of  persons  apparently  well,  and  who, 
so  far  as  any  one  knows,  have  not  had  diphtheria ;  and  while 
we  know  that  the  poison  may,  under  favorable  circumstances, 
cling  for  a  very  long  time  to  articles  which  have  been  about 
a  patient,  yet  there  are  so  many  doubtful  points  about  the 
''virulence"  of  these  persisting  bacilli,  so  many  possibilities 
of  reinfection,  that  it  is  impossible  to  know  the  truth  with 
exactness.  But  given  a  house  which  had  been  ''thoroughly 
disinfected,"  and  which  had  for  a  while  stood  untenanted, 
we  should  think  that  it  was  very  probably  as  safe  as  most 
houses.  And  in  this  case  whatever  harm  is  likely  to  follow 
is  already  done.  Nevertheless,  we  do  feel  that  the  owner  of 
the  house  ought  in  fairness  to  tell  the  renter  of  the  circum- 
stances. 


HYGIENE  AND  SANITATION  367 

DANGER  OF  TYPHOID   FEVER  TO   BABIES  FROM   IMPURE 
DRINKING-WATER 

Are  young  babies  ever  exposed  to  the  danger  of  contracting 
typhoid  fever  from  impure  drinking-water? 

The  young  baby,  perhaps,  is  least  exposed  to  danger  from 
impure  drinking-water  because  it  uses  little  of  it.  If  it  is  on 
the  breast  it  drinks  little  but  breast  milk;  if  it  is  artificially 
fed,  the  milk  and  the  water  it  uses  are  commonly  raised  to  or 
near  to  the  boiling-point  in  the  course  of  preparation.  This 
fact,  probably,  is  one  of  the  reasons  why  typhoid  fever  is  so 
much  less  common  in  children  under  one  year  than  in  later 
childhood. 

SUSCEPTIBILITY  TO  SECOND  ATTACKS  OF  DISEASE 

I  have  been  told  that  a  baby  having  a  contagious  disease  while 
nursing  will  be  liable  to  take  it  again.  My  little  girl  had  the 
measles  when  ten  months  old.  Do  you  think  she  would  take 
it  again  if  exposed? 

There  is  no  such  rule.  Children  under  six  months  are  not 
very  susceptible  to  measles  or  scarlet  fever,  and  those  under 
four  months  have  very  nearly  an  immunity  from  the  latter 
disease.  But  a  great  many  children  have  these  diseases  in 
the  second  half  of  the  first  year.  It  is  true,  also,  that  a  good 
many  persons  have  them,  especially  scarlatina,  more  than 
once.  All  any  one  would  be  justified  in  saying  is  this:  If 
a  child  has  measles  under  six  months  of  age  it  is  likely- 
other  things  being  equal— that  it  is  unusually  susceptible. 
Such  a  child  is,  of  course,  more  liable  to  second  infection  than 
another.  In  your  child 's  case  there  is  no  ground  for  unusual 
anxiety. 

PHYSICAL  EXERCISE   FOR   GIRLS 

What  physical  exercises  are  best  adapted  for  girls  as  distin- 
guished from  boys?    More  particularly,  ought  girls  from  five 


368  THE  CENTURY  BOOK  FOB  MOTHERS 

to  seven  years  of  age  to  walk,  run,  and  jump  as  much  as  boys 
of  the  same  age? 

Girls  from  five  to  seven  years  of  age  may  practically  have 
the  same  exercises  as  boys  of  the  same  age,  with,  perhaps,  only 
a  little  reserve  as  to  heavy  exercise  (in  proportion  to  age), 
because  even  at  this  early  age  the  boy  usually  shows  some- 
thing of  the  superior  muscular  strength  that  is  so  marked 
in  adult  life.  But  they  may  walk,  run,  and  jump  like  boys 
if  they  are  not  unusually  excitable  girls. 


DISINFECTING   PAPER  MONEY   FROM  A  SICK-ROOM 

Is  there  any  way  of  disinfecting  paper  money  kept  in  a  room 
where  there  was  a  patient  seriously  ill  with  diphtheria? 

You  can  disinfect  paper  money  without  damaging  it  by  either 
of  two  easy  methods :  Pour  a  little  alcohol  on  a  piece  of  sul- 
phur and  burn  them  on  a  brick  or  flat  stone,  laying  the  bill 
near  them,  and  covering  all  with  an  inverted  stone  jar  so  as 
to  secure  the  fumes;  or  soak  the  bill  in  a  two-per-cent.  solu- 
tion of  carbolic  acid  and  water.  If  one  has  a  formaline  lamp 
its  fumes  are  best  of  all. 


BABY   POWDER 

What  kind  of  starch  or  chalk  do  you  consider  innocuous  when 
used  as  baby  powder  for  the  customary  purposes  of  drying 
the  skin? 

Buy  the  best  starch  and  pound  it  into  powder,  sifting  it 
through  coarse  Swiss  muslin  or  cheese-cloth.  Perfume  it 
with  orris-root,  and  you  have  a  harmless  *'baby  powder." 
Avoid  the  chalk  as  a  toilet  article.  It  has  some  value  in  cer- 
tain conditions  of  irritated  skin,  but  should  not  be  used 
habitually. 


HYGIENE  AND  SANITATION  369 

THE  VALUE  OF  WATER   IN   RHEUMATISM 

Please  give  me  your  opinion  of  the  value  of  distilled  water  for 
children  who  have  evidently  inherited  a  tendency  to  rheuma- 
tism. Will  its  continued  use  eradicate  the  rheumatic  poison 
from  the  blood?  Would  a  child  given  distilled  water  suffer 
from  the  lack  of  the  salts  contained  in  natural  water?  Is 
distilled  water  hurtful  in  any  way?  The  child  is  four  years 
old,  and  has  had  occasional  rheumatic  pains,  but  the  general 
health  is  fairly  good.  She  has  subsisted  mainly  on  cow's 
milk,  and  never  had  an  acute  attack  of  rheumatism. 

We  believe  that  water,  distilled  or  otherwise,  is  very  bene- 
ficial for  those  who  have  the  rheumatic  peculiarity.  We  do 
not  know  that  distilled  water  is  any  better  than  a  pure,  fairly 
soft  drinking-water.  We  do  not,  however,  think  the  distilled 
water  hurtful.  But  we  do  not  suppose  that  water  will  re- 
move the  tendency,  which  is  usually  an  inheritance,  while  it 
will  help  to  relieve  attacks  or  even  chronic  pains. 

THE  TREATMENT  OF  NERVOUS  CHILDREN 

My  youngest  child,  nearly  a  year  old,  seems  to  inherit  from  his 
parents  the  nervousness  which,  to  a  greater  or  less  extent,  all 
our  children — six  in  number — manifest.  I  confess  I  am  dis- 
couraged, for,  in  spite  of  my  most  earnest  endeavors  to  keep 
baby  quiet,  he  is  restless,  especially  at  night.  In  most  essen- 
tial respects  he  is  well — in  fact,  he  is  pronounced  by  many 
mothers  of  my  acquaintance  an  unusually  fine  and  well-devel- 
oped child.  His  food  appears  to  agree  with  him,  and  he  has 
been  quite  a  lively  toddler  since  he  was  ten  months  old.  Still, 
I  am  troubled  by  his  tossings  and  his  evidently  vivid  dreams 
at  night;  and,  if  possible,  would  like  to  save  him  from  at 
least  the  graver  form  of  nervousness  (St.  Vitus's  dance)  which 
has  overtaken  one  of  his  older  brothers. 

Do  you  think  nervousness  is  inherited?  And  how  ought  ner- 
vous children  to  be  treated? 

Are  such  children  generally  more  brilliant  than  other  children 
of  their  age? 

Are  vivid  dreams  always  a  sign  of  mental  fatigue? 
24 


370       THE  CENTURY  BOOK  FOR  MOTHERS 

Nervousness  is  considered  by  most  competent  authorities  on 
the  subject  to  be  more  apt  to  be  inherited  than  almost  any 
other  infirmity,  and  the  children  of  parents  who  are  of  a  ner- 
vous disposition  are  therefore  doubly  exposed  to  those  influ- 
ences which  produce  nervousness.  As  the  imitative  faculty 
is  very  strong  in  children,  such  parents  should  be  careful  to 
suppress  any  eccentricities  of  gesture  and  temper  that  they 
themselves  may  indulge  in,  lest  the  children  acquire  them  in 
an  exaggerated  form.  In  dealing  with  nervous  children  ex- 
cessive tenderness  and  sentimentality  are  as  injurious  as  ex- 
cessive harshness. 

Nervous  children  are  very  apt  to  appear  endowed  with 
brilliant  talents  at  an  early  age,  and  the  parents  in  their  not 
unnatural  pride  often  encourage  this  brilliancy,  instead  of 
restraining  it  and  allowing  the  brain  to  take  a  normal  course 
of  development  that  will  not  lead  to  premature  exhaustion 
or  collapse.  In  other  cases,  almost  as  frequent,  nervous  chil- 
dren appear  to  be  endowed  with  less  than  normal  mental 
gifts,  and  in  these  cases  it  is  quite  as  injurious  to  force  and 
urge  them  on  in  the  vain  struggle  to  overtake  their  more 
gifted  companions.  The  victims  of  such  a  mistaken  policy 
often  become  confirmed  invalids  in  after-life. 

Vivid  dreams,  especially  when  they  are  of  a  disagreeable 
nature  (as  most  vivid  dreams  are),  are  quite  as  fatiguing  as 
real  experiences.  Consequently  the  brain  gets  no  rest,  or 
but  little,  during  a  sleep  disturbed  by  such  dreams.  Avoid 
everything  that  may  excite  the  child  during  the  day,  and 
especially  near  bedtime.  For  the  same  reasons— speaking  of 
older  children— nothing  can  be  more  reprehensible  than 
the  habit  of  allowing  them  to  sit  up  late,  or  of  taking 
them  to  entertainments  in  the  evening.  Quiet  sleep,  fresh 
air,  and,  in  certain  cases,  judicious  use  of  cold  baths,  are 
the  best  medicines  for  nervousness  in  children  within  the 
range  of  domestic  practice.  It  is  worth  remembering 
that  overfeeding,  especially  late  in  the  day,  may  disturb 
sleep.  Sometimes  one  bottle  less  in  the  day  is  the  needed 
change. 


HYGIENE  AND  SANITATION  371 

THE   HARDENING  THEORY 

I  should  like  to  ask  you  a  question  about  our  fourteen-months- 
old  baby  daughter.  She- is  doing  very  well  in  every  way,  and 
is  considered  by  all  who  see  her  a  strong  and  well-developed 
child.  She  is,  however,  subject  to  colds.  My  husband  is  a 
believer  in  the  hardening  theory,  and  thinks  that  it  would  be 
well  for  her  to  get  a  cold  bath  every  day,  summer  and  winter, 
even  when  she  seems  to  have  a  running  cold.  I  should  like 
your  opinion  on  that  subject  before  cooler  weather  sets  in. 
She  enjoys  the  cold  bath  very  much  at  present. 

To  begin  with,  we  have  no  opinion  of  the  "hardening"  the- 
ory except  that,  as  generally  interpreted,  it  is  a  great  stu- 
pidity. We  do  not  of  course  mean  to  advocate  foolish  cod- 
dling. The  ''hardening"  method  in  any  shape  should  not 
be  begun  on  a  little  child.  As  to  the  cold  baths,  we  note 
that  you  do  not  mention  the  kind  of  bath,  but  we  presume 
that  you  mean  an  immersion  bath.  "Cold"  bath  is  used 
very  vaguely  in  common  conversation,  but  to  a  medical  man 
it  means  a  bath  between  50°  F.  and  70°  F.  Now,  a  bath 
drawn  from  the  cold  tap  in  New  York  City,  in  the  middle 
of  a  warm  July  day,  is  about  70°  (if  there  has  been  a  pro- 
longed "hot  spell"  it  will  mark  something  higher).  This 
even  gives  a  distinct  chill  when  one  enters  it,  which  is  soon 
lost  to  a  strong  adult;  but  the  baby's  surface  area  is  much 
greater  in  proportion  to  its  mass  than  the  adult's,  and  it  is 
in  the  same  proportion  more  easily  chilled.  Suppose  baby 
weighed  twenty  pounds,  and  his  father  one  hundred  and 
sixty :  baby 's  mass  to  the  father 's  is  1 :  8 ;  his  surface  is  1:4, 
and  he  chills  twice  as  fast,  making  no  allowance  for  the  rela- 
tively greater  impressionability  of  the  child 's  nervous  system, 
which  still  further  exaggerates  the  disparity.  As  the  tem- 
perature of  the  bath  is  lowered,  the  depression  is  proportion- 
ately greater.  In  fever  the  cold  bath,  used  with  discretion, 
and  by  those  who  know  its  effects,  is  a  valuable  remedy,  but 
it  is  potent  for  mischief  if  used  stupidly. 

As  to  "hardening,"  once  more  we  would  say  that  we  do 


372       THE  CENTURY  BOOK  FOR  MOTHERS 

not  think  well  of  cold  baths,  in  the  usual  sense,  for  an  infant 
or  a  little  child.  If  the  immersions  are  only  for  a  few  sec- 
onds they  may  do  no  harm,  but  in  our  opinion,  in  cool  weather 
at  least,  a  better  bath  for  the  purpose  is  this :  Stand  the  child 
in  lukewarm  water  no  more  than  ankle  deep,  and  sponge  it 
over  with  water  of  about  70°  F.  from  a  bowl  at  hand.  Any 
necessary  washing  with  lukewarm  water  and  soap  to  cleanse 
soiled  parts  of  the  person  is  to  be  previously  done.  By  this 
method  all  the  advantages  of  the  cold  bath  are  gained,  with- 
out its  drawbacks. 


HARDENING   IN   PRACTICE 

I  have  two  boys,  aged  three  years  and  eight  months  and  five 
years  and  four  months,  who  have  from  about  the  fourth  month 
of  their  lives  been  accustomed  to  a  daily  cold  bath.  In  sum- 
mer I  use  for  them  the  water  as  it  comes  from  the  faucet, 
in  winter  I  raise  the  temperature  to  70°  for  the  younger  boy 
and  to  60°  for  the  older.  They  not  only  enjoy  their  daily 
bath,  never  experiencing  a  chill,  but  often — even  in  winter — 
beg  for  "more  cold,"  and  consider  it  a  treat  when  the  cold 
water  is  turned  on  and  they  are  allowed  to  put  their  head  and 
neck  under  the  faucet. 

Now  for  the  practical  side  of  it.  Neither  boy  has  ever  been 
seriously  ill,  the  older  has  had  only  a  slight  attack  of  the 
measles,  and  both  are  remarkably  free  from  even  ordinary 
colds.  Must  I  look  for  dire  results  in  the  future,  as  a  conse- 
quence of  my  hardening  theory  and  practice? 

No.  You  are  not  to  "look  for  dire  results."  It  happens 
that  you  have  a  pair  of  children  who  can  stand  the  regimen, 
and  we  know  a  good  number  of  such;  but  we  know  a  great 
many  more  who  cannot.  The  same  argument  which  is  ad- 
duced for  "hardening"  is  also  used  for  violation  of  every 
rule  of  diet.  ' '  See  my  child  ! ' '  exclaims  the  proud  parent. 
"Ever  since  he  was  off  the  bottle  he  has  eaten  whatever  was 
on  the  table.  Does  he  not  look  well?"  This  is  the  rule  of 
life  in  a  large  class  of  the  community,  where  a  high  infant 


HYGIENE  AND   SANITATION  373 

or  child  mortality  is  looked  on  as  normal.  But  in  advising 
our  readers  we  advise  what  we  believe  (and  in  this  we  find 
we  agree  with  the  almost  unanimous  opinion  of  those  who 
study  the  hygiene  of  childhood)  is  best  for  the  great  major- 
ity. Wherever  a  child  shows  greater  vitality  than  is  usual, 
or  less  susceptibility  to  morbific  influences,  there  is  no  need 
for  him  to  be  as  carefully  kept  as  others. 


RATIONAL  AND   INJURIOUS   SCHOOL- WORK  ;  THE 
SCHOOL  LUNCH 

Is  it  injurious  for  young  children  to  do  their  lessons  in  the 
evening?  How  many  hours  ought  a  child  of  eight  to  spend 
in  such  work?  How  can  one  tell  whether  a  child  is  over- 
worked?    What  is  a  proper  school  lunch? 

If  by  * 'young  children"  is  meant  those  under  ten,  they  have 
no  evening.  They  should  be  in  bed  at  8  p.m.  The  little  in- 
terval between  their  evening  meal  and  bedtime  should  be 
spent  quietly  preparing  for  a  restful  night. 

The  school  day  of  a  child  of  eight  does  not  exceed  five  hours 
in  the  public  schools,  in  private  schools  usually  less.  This 
includes  study,  recitations,  and  everything.  Outside  study 
is  not  expected,  and  rightly.  The  writer  believes  that  nearly 
all  the  symptoms  of  overwork  in  school  are  due  to  other  causes 
and  occur  about  the  same  whether  the  child  attends  school  or 
not.  They  coincide  with  the  developmental  age.  If  there  ap- 
pear any  signs  of  ill  health  it  is  proper  to  consider  the  cause, 
but  not  to  assume  over-study  until  every  sort  of  mal-hygiene 
has  been  considered.  We  have  known  a  child  removed  from 
school,  by  medical  advice,  as  overtaxed,  when  the  physician 
had  been  kept  in  ignorance  of  the  fact  that  the  child  had  a 
standing  order  at  the  grocer 's  for  a  daily  supply  of  indigest- 
ibles  sufficient  to  upset  a  whole  nursery.  And  these  instances 
might  be  adduced  indefinitely.  The  chances  are  entirely  in 
favor  of  a  bodily  and  not  a  mental  cause  of  the  fagged  con- 
dition of  the  pupil. 


374       THE  CENTURY  BOOK  FOR  MOTHERS 

The  proper  school  lunch— still  considering  young  chil- 
dren of  eight  or  thereabouts— is  a  light  one.  Plenty  of  time 
must  be  given  for  breakfast.  The  midday  meal  must  be 
ready  when  the  child  comes  from  school.  The  lunch  is  only 
a  snack  about  eleven  o'clock— bread  and  butter,  a  few  bis- 
cuits, with  an  orange  or  an  apple,  or  a  similar  ''life-saving 
station"  is  all  that  is  desirable.  If  school  is  arranged  so 
that  there  is  an  interval  to  go  home  for  lunch,  then  the  ques- 
tion solves  itself— the  lunch  is  a  good  warm  luncheon.  If 
the  hours  do  not  permit  the  eleven-o'clock  snack,  and  a 
heavier  luncheon  must  be  carried  to  school,  it  -will  depend 
upon  the  condition  of  things  at  home  just  what  it  shall  be. 
But  it  must  be  simple ;  it  must  be  nutritious  and  digestible 
—  good  bread  and  butter,  either  alone  or  in  the  form  of  a 
sandwich  made  with  a  thin  slice  of  tender  meat  or  mince. 
No  pie  or  cake ;  fruit  should  be  used  in  its  place.  Try  to 
make  the  child's  luncheon  look  tasteful  and  inviting,  and 
teach  him  to  make  it  so  himself,  if  practicable.  Have  a 
lunch-basket,  if  possible;  not  one  of  those  close  tin  lunch- 
boxes,  without  ventilation,  which  gives  to  the  best  luncheon 
an  unpleasant  odor.  All  these  niceties  promote  appetite  and 
digestion.  Details  as  to  luncheon  cannot  be  given.  The 
conditions  of  a  town  child  whose  home  is  only  five  squares 
from  the  school  are  not  the  same  as  those  of  the  country 
child,  who  has  to  make  a  long  journey  to  the  school-house. 


OVER-STUDY  AS   A  CAUSE  OF  CHOREA 

My  little  girl  of  ten  shows  symptoms  of  St.  Vitus's  dance. 
Should  she  be  taken  out  of  school?  And  is  it  likely  that  ex- 
cessive study  is  the  cause  of  the  trouble? 

School  life  has  been  charged  with  a  considerable  influence  in 
the  production  of  chorea.  There  is  no  doubt  that  a  choreic 
child  should  be  relieved  from  enforced  use  of  its  eyes  and 
from  the  often  inconsiderate  society  of  its  schoolmates,  but 
that  school  life  or  study  is  very  often  the  main  factor  in  the 


HYGIENE  AND  SANITATION  375 

cause  of  the  disease  we  must  doubt.  Its  greatest  frequency 
coincides  with  the  developmental  age— six  to  fifteen— and  we 
believe  that  it  is  as  likely  to  occur  in  children  out  of  school 
as  in.  The  frequency  with  which  the  disease  appears  in 
spring  has  been  thought  to  depend  upon  the  fatigue  of  the 
preceding  winter's  school  work.  We  believe  that  it  should  be 
charged  rather  to  the  defective  hygiene  of  the  winter,  and 
very  probably  to  the  enforced  abstinence  from  fresh,  espe- 
cially green,  vegetable  food  through  the  cold  months. 


XXII 
QUESTIONS  OF  DRESS 


THE   KNITTED   BAND;   GETTING   RID   OF  THE 
PINNING-BLANKET 

Can  you  tell  me  how  large  to  make  the  knitted  bands  for  an 
infant?  I  have  but  one  child,  and,  as  he  was  dressed  the  old- 
style  way  with  many  bands,  I  thought  that  I  could  do  much 
better  with  the  Gertrude  suit. 

I  would  also  like  to  ask  how  they  do  with  the  pinning-blanket 
— make  it  like  a  skirt  or  leave  it  off  altogether?  I  suppose 
that  you  will  tell  me  to  let  the  band  go  after  the  first  month 
or  so,  but  my  boy,  now  eight  years  old,  had  severe  trouble  with 
his  bowels,  and  if  I  took  off  the  flannel  band  he  would  be  much 
worse.  I  also  used  the  band  to  button  the  stocking-supporters 
on,  using  the  supporters  as  soon  as  he  was  put  in  short  clothes. 
He  wore  long  woolen  stockings,  keeping  his  knees  and  legs 
warm. 

A  knitted  band  should  be  rather  loose;  one  that  is  tight 
enough  to  hold  up  stockings  is  too  tight.  Its  only  use  being 
for  warmth,  it  should  be  wide  enough  to  cover  the  whole 
abdomen,  say  from  just  below  the  breast  to  the  hips. 

One  of  the  merits  of  the  Gertrude  suit  is  that  it  gets  rid 
of  the  pinning-blanket. 

SEASONABLE   DRESS   FOR   A   FIVE-MONTHS-OLD; 
SILK   OR   FLANNEL? 

My  baby  is  five  months  old,  and  has  always  worn  long-sleeved 
and  high-necked  silk  shirts,  but  I  find  that  his  arms  and  shoul- 
ders are  generally  cold.     Shall  I  put  flannel  on  him  instead? 

376 


QUESTIONS  OF  DRESS  377 

What  should  be  the  day  garments  for  spring?  When  summer 
comes  should  I  make  any  difference? 

Silk  is  cold  wear  for  winter,  and,  when  damp  with  perspira- 
tion in  summer,  clings  disagreeably  to  the  skin,  besides  be- 
coming almost  as  impervious  as  oiled  silk  to  air  and  moisture, 
and  thus  hindering  the  action  of  the  pores.  Fine  silk-warp 
flannel  is  better  wear  for  all  seasons,  certainly  for  warm 
weather.  Lighten  his  upper  garments,  should  he  suffer  from 
heat,  and  exchange  the  damp  for  dry  flannel. 

Garments  for  spring  should  be  the  same  as  for  winter,  but 
of  lighter  material.  Substitute  short-sleeved  and  low-necked 
shirts  for  those  he  now  wears  when  the  heats  of  summer  be- 
gin. Be  careful  not  to  leave  off  the  flannel  skirt  and  band 
too  early  in  the  season.    Wait  for  July  days  for  this. 

NIGHT   COVERINGS 

What  shall  I  do  to  keep  my  baby  boy  warm  at  night?  What- 
ever I  do,  he  will  get  outside  the  bed-clothes.  I  fear  that  by 
doing  so  in  winter  weather  he  will  get  pneumonia.  He  has 
recently  had  a  severe  cold,  taken  in  that  way.  A  few  weeks 
ago  I  put  flannel  night  drawers,  with  feet,  on  him,  and  con- 
sider them  a  very  good  article,  but  that  is  not  enough  cover- 
ing. I  have  thought  somewhat  of  making  a  large  flannel  bag 
to  put  him  into,  and  yet  that  does  not  seem  exactly  a  com- 
fortable  thing. 

Besides  the  sleeping-drawers  we  are  in  the  habit  of  advising 
one  of  two  things:  The  careful  securing  of  the  covers  by 
tapes  or  strong  safety-pins— large  sizes  are  made  for  the 
purpose— or  the  blanket  bag  you  suggest.  The  latter,  you 
probably  know,  is  the  plan  pursued  by  explorers  and  hun- 
ters in  cold  weather.  As  a  baby's  napkins  must  be  changed 
at  night,  the  bottom  of  the  bag  may  have  a  flap  to  button 
over,  in  which  case  it  is  really  only  a  nightgown  closed  at 
the  bottom.  It  should  be  made  very  wide  to  permit  free 
movement  of  the  limbs. 


378  THE  CENTURA  BOOK  FOR  MOTHERS 

THE   NIGHTCAP;   STOCKINGS   AT   NIGHT 

Should  a  baby  with  little  or  no  hair,  inclined  to  perspire  about 
the  head  and  neck,  wear  a  nightcap?  Should  he  wear  stock- 
ings at  night?  Can  any  rule  be  given  as  to  the  amount  of 
bundling  and  wrapping  a  young  baby  requires? 

"VVe  know  of  no  use  for  nightcaps.  The  child  can  be  better 
protected  from  draft  in  other  ways.  The  stockings  are  not 
necessary  if  the  bed-clothes  are  suitable  and  kept  in  place. 
The  only  rule  is  evenness  of  protection  and  sufficient  warmth 
without  burdensome  weight. 


SUMMER   DRESS 

I  should  like  to  ask  you  how  I  shall  dress  my  baby  boy  of  eight 
months  in  the  summer  so  that  he  may  be  warm  enough  and 
not  too  warm;  he  seems  to  feel  the  heat  very  much.  Would  a 
Canton  flannel  nightgown  that  has  been  worn  in  winter  be 
too  warm?  Ought  he  to  wear  merino  stockings,  as  he  is 
doing  now,  or  will  cotton  ones  be  better? 

A  loose  and  ample  garment,  with  shirt,  napkins,  and  stock- 
ings under  it,  will  be  enough  in  hot  weather.  Cotton  stock- 
ings have  no  particular  advantage  as  to  coolness  over  merino 
if  the  former  are  sufficiently  stout  to  be  of  any  use  to  a 
strong  baby ;  so  we  think  that,  all  things  considered,  you  will 
find  the  advantages  on  the  side  of  the  merino.  The  Canton 
flannel  will  not  be  too  warm,  but  woolen  flannel  is  more  por- 
ous and  generally  more  comfortable.  If  night-drawers  closed 
at  the  feet  are  used,  no  other  cover  is  needed  in  very  hot 
weather. 

SUMMER   NIGHT-CLOTHING 

Will  you  advise  me  what  material  for  night-clothes  you  would 
consider  best  suited  this  summer  to  the  needs  of  an  eighteen- 
months'  child,  who  will  pass  the  season  at  the  seashore  and  has 
still  the  stomach  teeth  to  cut? 


QUESTIONS  OF  DRESS  379 

A  light,  fine,  cotton-and-wool  flannel  makes  the  best  sum- 
mer night-garments.  With  proper  washing  it  does  not  full, 
and  it  is  in  every  way  safer  than  muslin  for  the  seashore, 
and  but  little  warmer. 


CLOTHING    FOR  WINTER 

What  is  the  wisest  way  to  dress  a  child  in  winter?  I  do  not 
approve  of  the  little  thin  white  dresses,  and  want  my  little 
girl  to  wear  fleeced  pique'. 

The  garments  should  be  planned  so  as  to  make  an  even  cov- 
ering for  the  whole  body,  and  should  be  such  as  to  seem 
comfortably  warm  to  you  for  your  house  and  climate,  with- 
out overloading  the  child.  All  babies  and  children  in  our 
winter  should  have  thick  woolen  undergarments.  The  heav- 
iest all-wool  merinos  that  you  can  find  of  children's  sizes  will 
not  be  too  warm.  They  should  be  high-necked  and  long- 
sleeved,  and  long  in  the  body.  Long  woolen  stockings,  held 
up  by  side  supporters,  are  an  excellent  protection,  and,  if 
possible,  let  the  child  wear  flannel  drawers  also,  for  the  skirts 
fly  about  and  cannot  be  depended  upon.  The  legs  of  the 
drawers  can  be  made  separate  to  button  on,  if  more  conve- 
nient. Then  comes  the  cotton  waist,  which  helps  to  protect 
the  chest  and  holds  the  flannel  skirt  and  drawers.  The 
fleeced  pique  would  be  comfortable,  but,  with  an  extra  flan- 
nel skirt  and  flannel  sack  underneath,  the  thin  dresses  can 
be  made  perfectly  safe.  A  few  house  sacks  are  useful  when 
the  rooms  happen  to  be  cooler  than  usual,  but  should  not  be 
habitually  worn. 

For  out  of  doors  have  a  thick  hood,  or  a  hat  which  will 
cover  as  much  of  the  head  as  a  hood,  with  warm,  broad  ear- 
pieces, fitting  closely,  and  a  hea^^  cloak.  If  the  child  walks 
she  should  have  thick  soles  and  leggings.  If  she  rides  she 
should  have  plenty  of  blankets  snugly  tucked  around  her 
under  those  used  chiefly  for  ornament.  Warm  mittens  are 
very  important,  and  care  should  be  taken  that  they  are  kept 


380       THE  CENTURY  BOOK  FOR  MOTHERS 

on  if  the  weather  is  cold,  for  the  child  cannot  be  comfortable 
if  the  hands  are  chilled. 


THE  VALUE  OF  LONG  STOCKINGS 

I  should  like  to  put  my  baby  in  short  clothes  in  June,  and  wish 
to  ask  what  kind  of  socks  I  should  put  on  him?  One  friend 
says  cotton,  another  says  merino  by  all  means  through  the 
first  summer.  If  the  latter  advice  be  followed,  will  there  not 
be  danger  in  changing  to  cotton  ones  later ;  or  would  this  neces- 
sitate putting  on  cashmere  ones  as  the  cold  weather  approaches  ? 

My  oldest  child  wore  merino  and  then  cashmere  stockings,  but  is 
subject  to  spasmodic  croup.  Is  there  any  truth  in  the  state- 
ment that  woolen  stockings  cause  a  tendency  to  croup  by  mak- 
ing the  feet  perspire  ?  If  this  be  true,  I  want  to  guard  against 
the  second  child  being  made  a  subject  for  croup. 

When  the  baby  is  put  in  short  clothes  he  should  have  stock- 
ings long  enough  to  cover  the  leg  and  knee  and  even  higher 
if  the  napkins  will  permit.  The  short  sock  commonly 
used  on  babies  has  no  value  except  to  keep  the  shoe  from 
touching  the  foot ;  it  generally  leaves  the  calf  and  knee  bare 
if  the  child  moves  his  legs  enough  to  throw  off  his  skirts. 
We  are  persuaded  that  the  secret  of  healthful  clothing  is 
the  uniform  protection  of  the  body ;  hence  a  method  of  dress 
that  leaves  open  patches  of  the  person  between  thickly  clothed 
ones  is  more  hazardous  than  simple  nudity.  A  child  should 
not  be  burdened  with  clothes,  but  the  protection  should  be  as 
evenly  distributed  as  possible;  hence  the  advice  about  the 
length  of  the  stockings. 

As  to  materials,  we  prefer  those  that  have  a  considerable 
amount  of  wool.  "Merino"  is  a  trade  name  for  knitted 
goods  containing  both  cotton  and  wool,  apparently  in  vary- 
ing proportions.  "Cashmere"  we  are  not  quite  certain 
about,  but  we  think  it  is  mainly  wool  with  some  cotton.  The 
reason  for  preferring  wool  is  that  through  it  changes  of  heat 
and  cold  are  less  quickly  felt.     It  has  been  found  that  light 


QUESTIONS  OF  DRESS  381 

woolen  fabrics  make  the  most  comfortable  as  well  as  the  safest 
summer  apparel. 

We  do  not  believe  that  croup  comes  from  the  cause  as- 
signed. If  the  shoe  is  sufficiently  large  the  woolen  stocking 
does  not  cause  perspiration,  and,  as  already  said,  a  change 
of  temperature  or  a  draft  of  air,  which  are  the  usual  causes 
of  a  checking  of  perspiration,  are  much  less  readily  felt 
through  wool  than  through  cotton. 

STIFF   SOLES   FOR  BABIES 

At  what  age  should  a  child  wear  stifi-soled  shoes  ?  Our  baby  has 
worn  kid  shoes,  with  soft  soles,  since  he  was  seven  months  old. 
He  is  now  one  year,  but  has  never  shown  any  inclination  to 
walk  or  creep.  He  is  large  for  his  age,  strong,  and  healthy. 
Will  a  stiff  sole  injure  the  shape  of  the  foot? 

The  stiff  sole  is  not  necessary  until  he  begins  to  walk  out  of 
doors ;  it  then  is  useful  to  prevent  bruising  of  the  foot.  The 
stiffness  of  the  sole,  if  the  shape  is  right,  will  not  change  the 
shape  of  the  foot;  but,  unfortunately,  the  shape  of  baby 
shoes  is  not  always  right,  although  they  are  usually  less 
atrocious  than  the  soles  made  for  adults. 

GARTERS   AND   STOCKING-SUPPORTERS 

What  do  you  consider  best  for  children,  the  round  garters,  above 
the  knee,  or  the  stocking-supporters  attached  to  the  waist? 

The  objection  to  the  circular  garter  worn  above  or  below 
the  knee  is,  of  course,  that  if  tight  it  interferes  wdth  the  free 
return  of  blood  from  the  leg.  The  objection  to  the  waist 
stocking-supporter  is  that  if  tight  it  draws  forward  too  much 
on  the  loins.  Now,  practically,  neither  does  harm  if  not 
too  tight.  If  one  tries  to  keep  a  silk  stocking  up  next  the 
skin  or  upon  slippery  underclothing,  a  tight  garter  of  either 
kind  is  needed  to  keep  the  stocking  free  from  folds.     But 


382  THE  CENTURY  BOOK  FOR  MOTHERS 

as  children  dressed  for  comfort  and  not  for  show  generally 
have  in  cool  weather  drawers  of  woolen  or  some  knit  goods 
and  stockings  of  wool  or  some  substantial  material,  the  stock- 
ing is  readily  kept  in  place  with  very  slight  pressure.  Very 
little,  for  instance,  is  required  to  keep  the  stocking  of  the 
bicyclist  or  sportsman  in  place.  In  our  judgment,  the  stock- 
ing-supporter is  preferable  if  the  garter  must  be  tight,  but 
if  the  child  is  properly  dressed  it  makes  little  difference. 
You  should  yourself  see  about  the  snugness  of  fit. 

In  the  case  of  the  Gertrude  suit,  if  you  prefer  the  sup- 
porter, you  can  put  supporting  buttons  upon  the  inner  gar- 
ment of  the  suit. 


PROPER   STOCKINGS   AND   SHOES   FOR  A 
DEPRESSED   TOE 

When  my  three-year-old  boy  was  born,  we  noticed  that  the  toe 
next  the  big  one  on  the  left  foot  was  inclined  to  turn  under 
the  next  one.  He  wore  chamois  moccasins  till  a  year  and  a 
half  old,  and  then  broad-toed  shoes;  but  I  find  the  toe  is  not 
getting  any  better;  the  big  toe  seems  to  push  over  and  almost 
meets  the  third  toe,  leaving  the  second  quite  underneath.  It 
does  not  seem  to  give  him  any  pain  now,  but  I  fear  will  do  so 
later — the  nail  seems  to  pass  almost  through  the  flesh. 

Is  there  anything  I  can  do  for  it?  We  thought  perhaps  stock- 
ings with  separate  toes  might  be  an  advantage,  but  do  not 
know  if  they  are  made  for  children — can  you  tell  me? 

Also,  can  you  tell  me  where  to  get  shoes  without  any  heels?  He 
is  wearing  the  largest  size  of  infant's  shoes,  and  the  next  size 
has  spring  heels.  I  cannot  see  wliy,  if  shoes  with  no  heels  are 
best  for  little  children,  they  are  not  always  best;  and  then  they 
all  have  such  thin  soles.  I  have  used  cork  soles  in  my  boy's 
shoes  all  winter. 

The  toe  may  have  had,  and  probably  did  have,  some  con- 
genital peculiarity.  The  management  of  such  toes  often  re- 
quires considerable  ingenuity.  The  intruding,  overlapping 
toe  must  be  kept  in  place.     Various  devices  have  been  used, 


QUESTIONS  OF  DRESS  383 

and  which  particular  one  is  best  adapted  to  this  case  we 
cannot  tell  by  description.  Often,  too,  after  the  depressed 
toe  has  occupied  such  a  position  for  a  time,  it  will  be  neces- 
sary to  raise  it  by  a  strip  of  adhesive  plaster  or  in  some  other 
way.  You  can  do  a  good  deal,  but  you  will  work  best  if  you 
have  the  advice  of  some  good  physician  of  your  neighbor- 
hood. Get  that  one  who  has  the  most  surgical  or  mechanical 
' '  knack. ' '  The  stockings  with  separate  toes  are  usually  knit 
to  order,  we  think. 

The  "spring  heel,"  meaning  only  a  thickening  of  the  sole 
at  the  back,  is  harmless.  The  essential  reason,  we  appre- 
hend, why  no  heels  are  used  for  any  young  children  is  to 
allow  them  as  free  movements  of  their  feet  as  possible  until 
they  get  control  of  them.  They  stumble  and  fall  very  read- 
ily at  best.  Any  stiff  sole  would  aggravate  this  tendency; 
later,  they  can  manage  a  stiffer  sole,  and  the  spring  heel  is 
only  a  slight  additional  protection  to  the  sole  of  the  foot. 
The  thinness  of  the  sole  need  not  be  prolonged  after  children 
have  good  use  of  their  limbs,  but  you  must  not  expect  the 
shoemaker  to  make  innovations  unless  loudly  demanded. 
Shoes  are  made  to  sell,  and  the  shoemaker  is  a  merchant,  not 
a  physiologist,  nor  usually  a  philanthropist. 

THE  ADVISABILITY   OF   GOING   BAREFOOT 

What  is  your  opinion  of  letting  infants  and  children  go  bare- 
foot? In  a  climate  like  that  of  Texas,  where,  as  some  one 
said,  it  is  nine  months  summer  and  three  months  very  late 
spring,  children  seem  to  do  this  with  impunity.  I  hesitate, 
however,  and  would  like  to  know  your  opinion  as  to  the  ad- 
visability of  getting  near  to  Mother  Earth. 

The  climate  of  Texas  we  know  only  by  hearsay.  The  feet, 
if  exposed  persistently,  become  hardened  on  the  sole  and  less 
sensitive  than  if  covered.  Apparently,  country  boys  suffer 
but  little  from  the  exposure  to  cold.  In  an  equable,  warm 
climate  it  is  probable  that  there  would  be  less  risk  than  in 
colder  or  more  variable  ones.     One  of  the  objections  to  going 


384  THE  CENTURY  BOOK  FOR  MOTHERS 

barefoot  is  the  susceptibility  to  injury.  Any  one  who  went 
barefoot  in  his  childhood  will  recall  the  painful  ''stone 
bruises, ' '  often  suppurating,  from  which  he  suffered.  If  the 
plan  of  going  without  shoes  is  adopted,  it  should  be  com- 
menced after  the  summer  has  really  begun.  It  is  easier  and 
safer  to  continue  as  the  weather  grows  colder  than  to  begin 
too  early. 


XXIII 
CARE  OF  THE  MOTHER 


NERVOUSNESS   IN   THE   MOTHER   AS  A   CAUSE   OF 
BABY'S   COLIC 

My  second  baby  was  from  birth  very  troublesome.  He  was  un- 
easy and  fussed  and  cried  the  greater  part  of  the  day,  and 
invariably  had  a  spell  of  colic  in  the  evening,  after  which  he 
would  settle  for  the  night.  This  continued  for  five  months, 
when  the  colic  spells  became  less  frequent,  but  the  restlessness 
and  lack  of  regular  habits,  except  in  nursing,  continued  until 
he  was  weaned  at  ten  months,  at  which  time  he  weighed  twen- 
ty-five pounds  nude. 

Every  effort  was  made  to  find  the  cause,  and  many  remedies  were 
used  to  cure  the  colic,  which  was  severe.  My  diet  was  given 
special  attention.  I  systematically  eliminated  one  article  of 
food  after  another  which  I  thought  might  cause  the  trouble. 

My  third  baby  was  from  birth  until  the  nurse  left  what  mothers 
call  "a  dear,  good  baby,"  but  after  I  began  to  care  for  her  she 
gradually  developed  the  same  symptoms  as  baby  number  two, 
but  with  less  severe  colic.  Again  I  looked  to  my  diet,  with  the 
same  result  as  before.     I  was  in  despair. 

I  consulted  my  physician,  as  I  had  with  my  former  baby,  but 
this  time  he  prescribed  for  me — harmless  sedative  tablets  for 
nervousness.  The  effect  was  immediate.  Baby  resumed  her 
happy  existence,  and  now,  at  five  months,  eats  and  sleeps  well 
and  regularly  in  spite  of  the  fact  that  I  eat  everything  I  desire. 
Even  such  articles  as  baked  beans,  boiled  onions,  or  turnips 
(which  I  began  to  eat  with  fear  and  trembling)  do  not  disturb 
her  in  the  least. 
25  385 


386  THE  CENTURY  BOOK  FOR  MOTHERS 

I  firmly  believe,  as  does  my  physician,  that  if  the  same  treat- 
ment had  been  followed  with  baby  number  two  he  would  have 
been  spared  much  misery  and  the  whole  household  much  worry. 

The  question  of  the  effect  of  the  mother's  emotions  or  ner- 
vous state  is  an  old  one.  The  books  give  cases  of  very  great 
damage  done  to  infants  by  nursing  after  the  mother  had 
undergone  strong  emotions,  notably  anger.  It  may  be  said 
that  these  cases  are  not  recent  and  have  not  the  preciseness 
in  detail  that  modern  science  demands.  Yet  we  think  that 
there  is  no  doubt  that  nervous  disturbances  on  the  mother's 
part  do  cause  symptoms  of  indigestion  in  the  infant.  Just 
what  changes  occur  in  the  milk  is  not  known.  Opportuni- 
ties are  usually  too  rare  to  enable  the  chemist  to  make  the 
delicate  analyses  which  might  show  the  nature  of  the  changes, 
and  it  is  very  probable  that  the  latter  would  be  beyond  our 
present  means  of  detection.  If,  however,  we  reflect  that  emo- 
tions will  affect  all  of  the  secretions— perspiration  and  urine, 
for  instance— will  change  the  action  of  the  bowels,  will  cause 
nausea  and  vomiting,  the  fact  that  the  milk  should  be  simi- 
larly modified  does  not  seem  remarkable. 

In  practice  it  is  well  to  consider  two  things  in  the  mother's 
condition:  First,  her  general  condition  of  health  as  modi- 
fying her  nervous  state,  and  individual  occasions  of  nervous 
excitement  or  irritation.  A  general  nervous  condition  will 
be  likely  to  give  rise  to  pretty  steady  disturbance  on  the  part 
of  the  child,  and  this  condition  can  be  best  treated  as  it  was 
in  the  case  of  our  correspondent.  When  some  single  source 
or  occasion  of  nervous  excitement  in  the  mother  has  once  pro- 
duced trouble  in  the  child,  it  will  be  well  to  be  on  guard  if 
such  excitement  occurs  again.  One  of  the  best  remedies  in 
common  use  is  asafetida.  Its  odor  is  disagreeable,  but  its 
value  as  a  soother  of  disturbed  nerves  is  established.  For- 
tunately, it  has  the  additional  advantage  of  being  a  notable 
remedy  for  colic  in  infants.  A  still  further  advantage  is 
that  it  is  not  poisonous,  and  is  laxative  rather  than  consti- 
pating. 


CARE  OF  THE  MOTHER  387 

When,  however,  the  question  of  a  child 's  colic  being  due  to 
the  mother's  nerves  comes  up,  in  every  case  all  other  causes 
should  be  considered  also.  Thus,  it  may  be  difficult  to  show 
—as  in  our  correspondent's  case— that  her  food  affected  the 
baby.  In  fact,  we  believe  that,  as  a  rule,  if  the  mother's 
food  be  well  digested  by  herself  it  is  not  likely  to  hurt  the 
baby.  But  in  this  very  case  we  note  that  the  child  at  ten 
months  weighed  twenty-five  pounds  nude— a  very  heavy 
weight— which  makes  one  wonder  if  the  colic  may  not  have 
been  partly  due  to  overfeeding.  Fussiness  with  rapid 
growth  is  very  suggestive  in  this  condition.  Probably  it  ex- 
plains many  of  the  common  cases  of  colic  which  torment  the 
baby  and  its  mother  for  three  months  and  then  cease.  The 
milk-supply  was  beyond  the  digestive  power  of  the  young 
baby,  but  it  eventually  caught  up  with  it. 

A   SENSITIVE   BREAST 

My  baby  is  seven  and  a  half  months  old,  weighs  seventeen 
pounds,  and  has  two  teeth  started.  She  has  never  been  sick, 
but  has  always  been  constipated,  having  only  one  movement  a 
day  after  an  injection  of  glycerin  and  water  (one  half  tea- 
spoon). I  nurse  her,  and  occasionally  I  feel  a  pricking  sen- 
sation in  my  nipple,  after  which  baby  draws  blood  with  the 
milk,  resulting  in  a  black  movement.  It  does  not  seem  to 
affect  her  otherwise,  but  I  know  something  must  be  wrong, 
and  ask  your  advice. 

It  is  probable  that  the  pricking  sensation  followed  by  blood 
is  from  a  slight  wound,  whether  from  a  bite  or  from  too  pro- 
longed or  too  hard  sucking  we  do  not  know.  If  it  seems  to 
be  from  the  latter  cause,  perhaps  it  could  be  avoided  by 
changing  to  the  other  breast  before  the  sensation  is  felt.  If 
it  occurs  only  on  one  side,  better  let  the  baby  feed  first  from 
the  other  side,  so  that  she  shall  not  pull  so  hard  on  the  tender 
side.  A  shield  may  prevent  this  trouble.  If  it  fails,  wean- 
ing is  the  cure,  and  it  may  be  begun  early  if  the  breast  is 
often  hurt— that  is,  often  enough  to  keep  it  sore. 


388  THE  CENTURY   BOOK  FOR  MOTHERS 


SORE   NIPPLES 

My  baby  is  bottle-fed  because  of  the  suffering  caused  by  sore 
nipples  and  two  gathered  breasts,  the  milk  having  been  so 
transformed  by  my  nervous  terror  from  the  pain  that  it  nearly 
killed  her.  Do  you  know  or  can  you  safely  recommend  a  cure 
for  sore  nipples? 

"Sure  cures"  rarely  exist  out  of  the  realm  of  popular  medi- 
cine. We  have  none  to  offer.  But  careful  attention  to  the 
following  details  generally  insures  immunity  or  speedy  cure. 
The  usual  causes  of  sore  nipples  are  two.  First,  want  of 
development  of  the  nipple,  which  makes  it  difficult  for  the 
child  to  nurse  without  violent  sucking;  a  similar  condition 
results  from  flattening  of  the  nipple  from  pressure  by  a  cor- 
set for  years,  the  nipple  becoming  broad,  but  not  prominent 
enough  for  the  lips  to  grasp  it.  The  second  cause  is  want 
of  cleanliness— not  want  of  ordinary  cleanliness,  but  of  ab- 
solute cleanliness,  or,  as  the  medical  phrase  is,  "surgical 
cleanliness."  It  may  be  said  at  the  start  that  some  persons 
—particularly  persons  subject  to  eczema— seem  to  have  a 
greater  tendency  than  others  to  these  nipple  troubles. 

When  the  nipple  is  not  well  developed  or  is  flattened, 
much  may  be  done  during  the  later  months  of  pregnancy  to 
elongate  it  by  gently  but  persistently  drawing  it  out  and 
at  the  same  time  pressing  backward  the  darkened  skin  (are- 
ola) around  it.  If  at  the  same  time  the  surface  of  the  nipple 
seems  to  be  tender,  it  can  often  be  hardened  by  frequent 
bathing  with  alcohol  or  with  some  astringent  solution,  such 
as  alum-water,  alcohol  and  alum,  witch-hazel  extract,  and  the 
like.  Occasionally  a  person  is  found  whose  skin  does  not 
tolerate  these  applications,  but  in  the  great  majority  of  cases 
they  agree  and  are  beneficial.  But  no  preliminary  prepa- 
ration will  be  effectual  if  the  details  of  toilet  of  the  nipple, 
presently  to  be  spoken  of,  are  not  heeded. 

Sore  nipples  are  of  two  kinds,  those  that  are  tender  or 
excoriated  ("raw")  and  those  that  are  fissured  or  cracked. 


CARE  OF  THE  MOTHER  389 

The  prevention  and  much  of  the  curative  treatment  are  the 
same  for  both.  The  former  are  usually  made  tender  first 
of  all  by  the  oozing  of  the  watery  liquid  that  precedes  the 
milk.  This,  with  the  moisture  of  baby's  mouth  and  a  little 
milk  (when  it  has  come)  left  after  nursing,  if  not  removed 
with  the  utmost  care,  will  remain  in  the  minute  folds  of  the 
nipple  skin  and  soon  set  up  an  irritation.  At  first,  to  the 
naked  eye,  or  even  with  a  magnifying-glass,  nothing  is  evi- 
dent but  a  redness  of  the  surface ;  but  this  spot  is  exquisitely 
tender,  and  many  women  who  have  bravely  borne  the  suf- 
fering of  labor  shrink  from  the  putting  of  the  baby  to  the 
breast.  This,  if  not  promptly  attended  to,  becomes  a  raw 
surface,  and  even  more  tormenting  than  before. 

Now,  from  the  start  the  nipple  should  be  kept  scrupu- 
lously clean.  It  should  be  bathed  before  suckling  and  after 
it.  Some  mild  and  unirritating  disinfectant  should  be  used 
— boracic  acid  is  our  own  preference— dissolved  in  the  warm 
water  employed  for  bathing  the  nipple.  It  will  be  worth 
while  to  examine  the  nipple,  and  particularly  its  base,  for 
wrinkles  and  folds  of  the  skin,  because  in  these  the  ferment- 
ing liquids  hide  and  set  up  the  irritation.  If  such  folds  be 
found,  they  may  be  washed  out  by  the  aid  of  a  camel's-hair 
pencil  or  a  little  wad  of  absorbent  cotton.  The  parts  should 
then  be  carefully  dried,  unless  the  attendant  thinks  it  better 
to  keep  some  soothing  wash  always  on  the  nipple  in  the  inter- 
vals of  nursing.  One  authority  advises  the  use  of  Goulard's 
extract— a  teaspoonful  to  a  tumbler  of  water— to  be  kept  for 
several  days  on  the  nipple  by  means  of  a  soft  cloth,  washing 
it  carefully  away  before  nursing. 

If  but  one  nipple  is  sensitive  the  task  is  easier,  for  then 
the  child  may  take  the  other  for  a  day  or  two,  the  tender 
breast  being  carefully  emptied  by  stroking  and  rubbing. 
Two  days'  rest  of  a  nipple  almost  always  results  in  a  cure. 
AVhen,  however,  both  nipples  are  troublesome,  they  require 
more  attention,  but  the  rest  of  both  breasts  results  in  a  dis- 
appearance of  the  milk  altogether. 

The  treatment  of  cracked  nipples  demands  the  same  pre- 


390  THE  CENTURY  BOOK  FOR  MOTHERS 

cautions  as  have  been  detailed.  In  addition,  the  fissures 
themselves  often,  if  not  usually,  need  local  treatment;  but 
as  this  can  be  well  carried  out  only  by  the  physician  or  a 
well-instructed  nurse,  it  is  not  worth  while  to  enter  into  it 
here. 

THE   DIET   OF   A   NURSING   MOTHER 

What  should  a  mother  eat  while  nursing  her  baby,  or  what  espe- 
cial things  should  she  avoid  eating? 

No  explicit  directions  can  be  given.  There  is  a  very  gen- 
eral belief  among  mothers  that  their  articles  of  food  may 
affect  the  suckling's  digestion.  There  is  nothing  improbable 
in  this,  since  we  know  that  some  drugs  taken  by  the  mother 
can  be  recognized  in  the  milk;  and  certainly  in  cow's  milk 
the  taste  of  certain  things— the  turnip,  for  instance— eaten 
by  the  cows  is  often  recognized.  In  practice,  however,  women 
are  not  harmonious  in  their  opinions  as  to  the  kinds  of  food 
which  do  affect  the  suckling,  and  some  medical  men  are 
skeptical  as  to  the  whole  matter.  For  ourselves,  we  think 
the  truth  is  about  as  follows:  Any  good  wholesome  food 
which  the  mother  can  ordinarily  fully  and  easily  digest— i.  e., 
without  distress,  acidity,  flatulence,  or  other  evident  disturb- 
ance—may be  eaten,  with  perhaps  the  exception  of  such  ar- 
ticles, chiefly  vegetable,  as  contain  a  strong  volatile  oil 
or  principle  such  as  we  can  recognize  by  the  taste  in  cow's 
milk.  Such  are  the  cabbage,  cauliflower,  turnip,  onion,  and 
garlic.  Now,  we  are  not  quite  sure  that  even  all  of  these 
need  in  every  case  be  avoided,  for  they  certainly  form  a  con- 
siderable part  of  the  diet  of  nursing  women  in  some  walks 
of  life.  Whether  in  those  cases  they  do  not  usually  affect 
the  infant,  or  Avhether  a  certain  amount  of  disturbance  of 
the  baby's  digestion  is  in  those  rather  unintelligent  circles 
considered  as  normal  or  unavoidable,  we  do  not  positively 
know.  We  should,  however,  advise  the  use  of  other  things  in 
preference ;  and,  in  case  these  vegetables  are  especially  craved 
or  are  needed  as  laxatives,  that  they  be  taken  cautiously  and 


CARE  OF  THE  MOTHER  391 

the  effects  noted.  There  are  many  articles,  notably  starchy 
things— white  bread,  potatoes,  beans,  etc.— which  some  per- 
sons digest  perfectly  and  others  only  with  the  formation  of 
much  gas.  Concerning  such  there  is  no  rule  beyond  indi- 
vidual experience.  It  would  be  a  pity  to  avoid  any  food  that 
is  wholesome  to  the  mother  if  it  is  not  really  disturbing  to 
the  child. 

We  believe  that  all  alcoholic  beverages  should  be  used 
sparingly  and  with  great  circumspection,  unless  ordered  by 
a  physician,  in  which  case  explicit  directions  as  to  the  dose 
and  the  period  during  which  they  are  to  be  used  should  be 
asked  for. 

THE   BEST   METHOD   OF   DRYING   UP  THE 
MOTHER'S   MILK 

What  is  the  best  method  of  drying  up  the  mother's  milk? 

Ordinarily,  absolutely  nothing  is  needed  but  to  let  the  breast 
alone.  If  the  breast  fills,  stroke  or  pump  out  the  milk.  Bel- 
ladonna ointment  applied  to  the  breast,  however,  hastens  the 
disappearance  of  the  milk  and  eases  pain,  but  do  not  let  the 
infant  get  any  of  the  ointment  in  its  mouth  or  eyes.  It  is 
very  poisonous. 

"NURSING  SORE  MOUTH" 
Can  you  give  a  cure  for  "nursing  sore  mouth"? 

The  disease  known  as  "nursing  sore  mouth"  is,  fortunately, 
a  rare  one  nowadays.  Some  thirty  years  ago  it  excited  much 
discussion  in  medical  journals  in  various  parts  of  this 
country.  It  has  been  known  to  be  epidemic  where  some 
bad  climatic  or  hygienic  conditions  have  existed.  The  dis- 
ease is  probably  always  dependent  upon  anemia  (thin  blood), 
and  it  sometimes  occurs  before  delivery,  and  has  even  at- 
tacked males.  Authorities  agree  that  the  surest  cure  lies  in 
tonics,  iron,  quinine,  cod-liver  oil,  good  food,  and  perhaps 


392  THE  CENTURY  BOOK  FOR  MOTHERS 

wine.  One  writer  goes  so  far  as  to  maintain  that  it  is  neither 
more  nor  less  than  scurvy.  The  best  preventives  are  good, 
generous  diet  and  good  hygiene  during  pregnancy  as  well 
as  during  the  nursing  period. 


EXCESS  OF  ABDOMINAL  FAT 

Is  there  any  safe  and  practical  way  of  removing  superfluous  fat 
from  the  abdomen?  The  nurses  here  never  bandage  after 
labor.  Would  that  account  for  it?  Immediately  after  the 
birth  of  each  of  my  two  children  there  has  seemed  to  be  no 
adipose  tissue  there  at  all.  Before  I  am  out  of  bed,  however, 
it  has  begun  to  be  deposited  all  over  the  surface  of  the  abdo- 
men, and,  alas!  it  continues  to  come.  My  general  health  is 
good.  I  take  much  out-door  exercise,  and  my  diet  is  mainly 
meat  and  fruits,  as  I  do  not  care  for  sweets  or  starchy  foods 
of  any  kind,  but  the  melancholy  fact  remains — and  I  fear 
the  trouble  will  increase — twenty-eight  inches  waist,  forty- 
eight  inches  hip !  I  know  this  question  has  nothing  what- 
ever to  do  with  the  care  of  babies,  but  as  the  trouble 
seems  to  have  been  caused  in  some  indirect  way  by  them, 
and  as  the  subject  will  doubtless  be  of  interest  to  others 
as  well  as  to  myself,  I  take  the  liberty  of  coming  to  you  for 
help. 

The  excess  of  abdominal  fat  after  delivery  is  not  dependent 
upon  the  absence  of  the  bandage.  We  have  often  seen  it 
occur  just  the  same  with  the  bandage.  The  peculiarity  is 
in  part  constitutional.  For  its  relief,  diet  will  do  something, 
kinds  of  food  and  amount  of  liquid  both  being  considered. 
But  during  lactation  a  good  deal  of  liquid  may  be  needed. 
Further,  we  believe  that  systematic  muscular  exercise  of  the 
abdominal  wall  is  useful,  in  that  much  of  the  protuberance  of 
the  abdomen  is  due  not  to  the  fat,  but  to  the  laxness  of  the 
muscles.  We  have  knowledge  of  instances  in  which  during 
a  course  of  exercise  several  inches  were  lost  in  girth,  while 
no  weight  was  lost.  Even  if  girth  be  not  reduced,  the  mus- 
cular gain  enables  one  to  be  more  active. 


CARE  OF  THE  MOTHER  393 

FALLING  OUT  OF  THE   HAIR  AFTER   CONFINEMENT 

In  behalf  of  some  of  my  friends,  as  well  as  myself,  I  want  to 
know  if  you  can  give  me  any  information  regarding  the  pre- 
vention of  the  falling  out  of  hair  after  confinement?  I  have 
very  heavy  hair,  but  after  the  birth  of  my  little  boy,  two  years 
ago,  I  lost  fully  one  fourth  of  it,  and  it  has  not  grown  in  to 
any  length  since  then.  Now,  a  frequent  recurrence  of  this 
would  be  most  disheartening.  Is  there  any  known  treatment 
of  the  scalp,  either  before  or  after  confinement,  that  could 
prevent  this? 

We  know  of  no  way  of  preventing  this  peculiar  fall  of  the 
hair,  which  is  of  very  common  occurrence  and  very  similar 
to  that  following  severe  illness,  particularly  if  attended  with 
fever.  Fortunately,  the  hair  usually  returns  as  fully  as  be- 
fore; but  as  a  very  long  time— many  months,  or  even  some 
years— is  required  for  it  to  gain  the  great  length  seen  on  some 
women,  the  frequent  recurrence  of  pregnancy  might  prevent 
its  reaching  its  original  length.  Applications  to  the  scalp 
are  useful  if  there  is  a  recognized  disease  of  the  scalp ;  but 
in  cases  where  there  seemed  to  be  no  local  disease  we  have 
not  been  able  to  see  that  the  growth  of  the  hair  was  more 
rapid  after  using  the  most  approved  local  applications  than 
in  those  instances  in  which  none  were  used. 


XXIV 

SPECIAL  REQUIREMENTS  AND  PERPLEXING 
POINTS  IN  THE  NURSERY   ROUTINE 

CRYING   AND   SEDATIVES 

To  what  extent  is  crying  harmless  in  babies?     The  cry  of  a 

baby  is  its  voice.     If  this  were  stifled  it  could  not  make  known 

its  discomfort  or  pain. 
Should  sedatives  be  given  ?     When  ?     In  what  quantities  ?    What 

is  a  safe  preparation? 
When  an  infant  of  a  few  days,  say  two  weeks,  sleeps  well  during 

the  day,  but  cries  at  night,  how  can  the  natural  relation  of 

day  to  night  be  restored? 

This  can  be  answered  only  in  a  general  way.  The  baby  has 
*'no  language  but  a  cry"  in  one  sense;  but  it  does  not  "cry 
for  joy."  If  a  baby  cries,  it  signifies  that  things  are  not 
as  it  washes  in  some  particular.  Of  the  various  cries  of  in- 
fancy many  are  usually  easily  recognized,  or  at  least  have 
been  catalogued  by  nurses  long  ago.  Pain,  weariness,  sleepi- 
ness, fright,  etc.,  are  among  the  causes  assigned  to  different 
cries.  To  many  children  the  cry  is  not  harmful,  but  the 
cause  of  the  cry— pain  or  fright,  for  instance— is.  We  pre- 
sume our  correspondent  wishes  to  know  when  crying  is  of 
itself  harmful.  It  rarely  is  so.  Children  occasionally  ''cry 
themselves  hoarse, ' '  and,  also  rarely,  a  fit  of  crying  may  ex- 
cite vomiting  if  the  stomach  be  full ;  but  neither  accident  is 
very  important.  Of  more  importance  are  the  fatigue  and  ex- 
citement dependent  upon  excessive  crying.  Violent  fits  of  cry- 

394 


PERPLEXING  POINTS  IN  THE  NURSERY  ROUTINE    395 

ing  are  assigned  as  a  cause  of  rupture  (hernia)  in  infants, 
and  possibly  correctly.  It  is  not  easy  to  describe  the  various 
cries  of  infancy.  Their  interpretation  is  learned  by  watching 
the  child.  The  main  point  is  to  make  sure,  if  possible,  whether 
any  removable  hurt  is  the  cause  of  the  outcry.  See  if  pins 
are  pricking  the  baby  or  if  it  is  too  tightly  diapered  or 
clothed.  Try  also  to  see  if  it  has  colic  or  indigestion,  and 
so  on. 

By  ^'sedatives"  we  presume  is  meant  not  what  are  called 
such  by  physicians,  but  anodynes  (relievers  of  pain)  or 
hypnotics  (sleep-producers).  Neither  the  one  nor  the  other 
should  be  given  under  any  circumstances  without  medical 
advice,  which  should  be  specific  as  to  dose  and  time  and  occa- 
sion of  repetition.  There  is  no  safe  preparation  for  infants 
or  young  children  without  such  advice. 

The  process  of  correcting  bad  sleeping  habits  is  often  very 
difficult,  and  taxes  the  ingenuity  of  the  nurse;  but  usually 
the  monthly  nurse  can  get  the  baby  well  started,  and  she 
should,  if  she  has  been  successful,  explain  her  methods  mi- 
nutely to  the  mother.  The  secret  of  success  is  not  in  drugs, 
but  in  systematic  and  regular  methods  with  the  baby. 


HARD   CRYING   AS   A   CAUSE   OF   RUPTURE 

Will  hard  crying  cause  a  baby  to  be  ruptured? 
Have  you  known  of  such  a  case  personally? 
Is  it  common  ? 


It  is  a  common  popular  belief.     But  w^e  think  that  hard  cry- 
ing has  not  this  effect  without  other  cooperative  causes. 

We  can  recall  no  case  in  which  the  relation  of  cause  and 
effect  was  clear.  Thus,  while  rupture  may  be  produced  in 
almost  any  one,  it  is  most  commonly  produced  in  those  whose 
abdominal  apertures  (the  inguinal  and  femoral  rings  of  the 
anatomists)  are  less  well  protected  than  in  others.  Again, 
while  we  think  that  a  normally  constituted  infant  would  very 
rarely,  if  ever,  rupture  himself  by  crying  if  the  abdomen 


396  THE  CENTURY  BOOK  FOR  MOTHERS 

were  free,  he  can  easily  do  so  if  all  the  elasticity  of  the  middle 
part  of  the  belly  is  destroyed  by  a  tight  girdle,  as  the  ''band" 
often  is  when  tightly  applied.  It  becomes  then  a  point  of 
resistance,  the  pressure  of  any  strain  is  concentrated  upon 
the  bottom  of  the  belly,  and  rupture  is  favored. 

Rupture  is  common  enough,  but,  as  we  have  said,  we  do  not 
think  it  common  from  crying. 

ROCKING   THE   BABY 

What  are  the  physiological  objections  to  rocking  a  baby?     Is  it 
likely  to  produce  congestion  of  the  brain? 

The  objections,  in  the  main,  are  not  physiological.  We  do 
not  believe  that  gentle  rocking  is,  save  in  exceptional  cases, 
harmful;  but,  on  the  other  hand,  it  is  not  beneficial.  The 
simple  holding  of  the  child,  by  the  support  and  warmth 
given,  is  as  quieting.  The  chief  objection  to  rocking  a  child 
is  the  habit  that  is  formed  of  going  to  sleep  in  an  unnatural 
w^ay.  Sleep  comes  naturally  to  the  tired  child  as  soon  as  it 
is  free  from  discomfort  and  is  left  alone.  In  saying  the 
above  we  do  not  mean  that  the  jolting  or  violent  oscilla- 
tion of  a  child  whose  stomach  is  full  is  harmless ;  we  believe 
that  favors  indigestion. 

AGE   FOR   SITTING   UP   IN   THE   CHAIR 

At  what  age  is  it  safe  for  a  baby  to  sit  up  in  its  chair  ? 

The  age  at  which  a  child  can  sit  up  varies  much,  and  de- 
pends entirely  upon  its  strength.  We  do  not  like  chairs  for 
very  young  children,  because  of  their  want  of  even  support 
and  their  insecurity.  A  child  should  be  allowed  change  of 
position  from  birth,  and  change  of  posture  as  soon  as  he  can 
change  it  himself  or  shows  a  desire  to  change.  To  this  end 
we  like  to  bolster  a  baby  up,  on  a  bed  for  instance,  with 
pillows.  His  head  and  trunk  are  then  well  supported,  and 
the  change  becomes  a  pleasure  and  not  a  tax. 


PERPLEXING  POINTS  IN  THE  NURSERY  ROUTINE    397 


BABY   IN   THE   CORNER 

Do  you  think  it  injurious  for  a  baby  to  sleep  in  a  corner?  Our 
room  being  very  small,  it  is  a  case  of  necessity  that  baby's 
crib  should  be  in  a  corner.  We  always  have  one  of  the  win- 
dows raised  several  inches  at  night  for  ventilation. 

There  are  corners  and  corners.  If  a  room  is  badly  venti- 
lated, corners  are  ordinarily  the  least  ventilated  parts.  If, 
on  the  other  hand,  the  room  is  one,  such  as  is  often  seen  in 
poorly  constructed  country  houses,  v^hich  is  the  arena  of 
contending  drafts,  a  corner  may  be  the  least  dangerous  part 
of  the  room.  A  small  room  with  a  window  open  ought,  we 
should  suppose,  to  be  sufficiently  ventilated  to  render  the 
air  in  the  corners  safe.  Another  aspect  of  the  question  is 
this:  If  the  corner  be  one  between  two  external  walls,  it  is 
likely  to  be  chilly,  if  not  damp ;  an  inside  corner  made  by 
lath-and-plaster  partitions  would  not  be  open  to  this  objec- 
tion. As  your  room  is  small,  it  presumably  has  sufficient 
light  as  w^ell  as  air. 

PLAYING   ON   THE   FLOOR 

I  have  two  little  ones,  the  elder  four  years  of  age  and  the  younger 
just  walking  alone.  Our  house  is  heated  by  a  furnace,  but 
there  always  seems  to  be  a  cold  draft  upon  the  floor,  where  my 
children  are  inclined  to  spend  most  of  their  time  with  their 
toys.  Can  you  suggest  a  plan  whereby  I  can  manage  to  keep 
them  amused  off  the  floor,  or  is  there  any  way  of  stopping  the 
drafts  ? 

While  heated  air  rises  and  cold  air  falls  there  must  always 
be  a  chill  current  near  the  floor.  Drafts  from  without  may 
be  partially  excluded  by  weather-strips  and  sand-bags,  but 
baby  sitting  on  the  carpet  is  almost  sure  to  take  cold  in 
bitter  weather.  A  cheap  mattress,  covered  with  a  quilt  or 
shawl,  makes  a  safe  place  for  him  on  windy  days.  One 
mother  had  a  sort  of  dais  or  platform,  six  feet  wide  and  six 


398  THE  CENTURY  BOOK  FOR  MOTHERS 

inches  high,  mounted  on  rollers  and  set  against  the  wall  of  the 
nursery,  for  "baby's  room."  In  default  of  these  conve- 
niences, give  the  twain  chairs  and  low  tables  of  their  own, 
and  teach  them  to  use  them  instead  of  sitting  on  the  carpet. 


THE   EFFECTS   OF  "JOSTLING  ABOUT" 

Will  you  tell  me  if  you  think  it  injurious  to  the  nervous  system 
of  infants  under  six  months  of  age  to  be  jostled  about  in  baby- 
carriages,  baby-jumpers,  etc.? 

We  do  not  know  that  such  jostlings  are  injurious  to  the 
"nervous  system,"  as  physicians  use  that  name— that  is,  in 
its  anatomical  sense— but  we  believe  they  do  increase  the 
timidity  and  excitability  of  children,  or,  in  other  words,  make 
them  "nervous,"  especially  if  already  inclined  that  way. 
We  do  not,  for  various  reasons,  think  a  baby-jumper  fit  for 
a  child  under  six  months  of  age;  and  at  any  age  a  child's 
carriage  should  be  trundled  with  care  and  without  unneces- 
sary jolting. 


RAPID   CARRIAGE-DRIVING   FOR  VERY 
YOUNG   CHILDREN 

Is  it  wise  for  babies  at  the  age  of  six  weeks  or  two  months  to 
be  driven  over  country  roads  with  fast  horses?  I  mean 
can  the  violent  exercise  cause  any  injury  to  so  young  a 
child? 

Unless  the  roads  are  unusually  smooth  or  the  vehicle  unusu- 
ally easy  such  exercise  is  undesirable.  It  is  comparable  to 
the  jolting  method  of  our  grandmothers,  when  a  rockerless 
chair  was  made  to  act  as  if  it  were  a  rocking-chair.  If  a 
young  child  is  taken  in  a  vehicle,  it  should  be  snugly  held 
against  the  breast  if  rapid  driving  is  necessary.  Under  such 
circumstances  it  should  be  protected  until  it  is  old  enough 
and  strong  enough  to  steady  itself. 


PERPLEXING  POINTS  IN  THE  NURSERY  ROUTINE    399 

METHODS   OF   LIFTING   THE   BABY 
Will  you  please  tell  me  how  a  child  should  be  lifted? 

A  baby  can  be  best  lifted  from  a  horizontal  position  by  put- 
ting one  hand  under  the  neck  and  shoulders  (or  shoulders 
alone  after  the  neck  becomes  strong)  and  the  other  under  the 
hips  or  seat.  And  it  is  always  well  to  support  the  back  when 
practicable.  It  often  will,  however,  be  necessary  to  put  the 
hands  for  a  moment  under  the  armpits. 

OBJECTIONS   TO   A  VEIL 

Do  you  consider  a  white  veil  injurious  to  a  baby's  eyes?  Is  it 
not  better  to  wear  none  rather  than  a  white  one? 

We  do  not  know  that  a  white  veil  is  much  different  from 
veils  of  other  colors.  We  think  the  texture  and  pattern  of 
more  harm  than  the  color.  Except  to  protect  from  severe 
wind  or  from  insects,  we  do  not  know  why  any  should  be 
worn  at  all.  The  child  should  not  be  placed  so  that  the  light 
glares  in  the  eyes. 

TEACHING   THE   USE   OF   THE   NURSERY   CHAIR 

Who  can  tell  me  how  I  can  teach  my  little  girl  to  ask  for  her 
nursery  chair?  She  is  nearly  two  years  old,  and  is  a  remark- 
ably good  child.  She  does  not  talk,  but  understands  every- 
thing we  say  to  her,  and  has  little  ways  of  her  own  of  asking 
for  everything  she  wants,  except  in  this  one  instance. 

I  spank  her  and  talk  seriously  to  her  about  it,  and  the  last  time 
she  cried  so  hard  and  so  long  that  she  was  completely  ex- 
hausted and  I  was  really  frightened;  so  I  feel  that  something 
besides  spanking  must  be  done  to  correct  the  fault.  I  have 
been  very  careful  to  put  her  on  the  chair  regularly,  but  I  can- 
not depend  upon  her,  and  I  never  know  when  she  is  going  to 
disgrace  me  in  the  most  public  places. 


400       THE  CENTURY  BOOK  FOR  MOTHERS 

Other  mothers  to  whom  I  have  spoken  on  the  subject  either  say 
they  never  have  had  any  trouble  in  the  matter,  or  else  they 
take  it  as  a  matter  of  course,  and  say  the  child  will  learn  when 
she  grows  older.     I  think  she  is  old  enough  now. 

There  is  no  good  way  but  to  wait.  It  may  easily— in  fact, 
it  constantly  does— happen  that  a  child  may  ask  "for  every- 
thing she  wants,"  meaning  every  concrete  thing,  and  yet  be 
quite  unable  to  express  a  want  of  the  sort  described.  We 
know  many  young  children  who  give  warning  of  their  need, 
but  not  by  asking.  Their  watchful  attendants  have  learned 
to  associate  the  child's  actions  or  expression  with  the  cause. 
Again,  one  child  may  have  ample  time  between  the  recog- 
nition of  the  desire  for  a  movement  and  its  fulfilment  to 
give  notice.  In  another  child— as  in  some  older  persons- 
there  is  no  such  interval.  Often  we  have  observed  children 
engaged  in  play  who  evidently  were  in  need  of  attention,  but 
who  were  so  absorbed  in  what  they  were  doing  as  to  be  un- 
conscious of  it,  until  led  away  by  the  attendants. 

Nothing  can  be  gained  by  spanking  and  frightening  a  child 
under  the  circumstances.  It  probably  will  make  matters 
worse.  If  you  are  obliged  to  take  the  child  into  a  public 
place— which  of  itself  often  excites  a  desire  for  evacuation 
of  bowels  or  bladder— and  fear  an  accident,  see  that  the 
bowels  are  relieved  by  enema  or  suppository  before  you  go. 

THE   CARE   OF   FINGER-NAILS 

Can  you  give  me  some  instruction  as  to  the  best  method  of  car- 
ing for  my  baby's  finger-nails — i.e.,  how  to  shape  them  in 
cutting,  and  how  to  prevent  the  skin  from  growing  up  over 
them?  Of  course  it  is  a  struggle  to  get  them  attended  to  at 
all,  but  I  want  to  do  it  in  the  best  way,  if  possible. 

In  our  judgment,  the  best  method  is  to  do  nothing  which  is 
not  necessary.  Trim  the  nails  as  smoothly  and  evenly  as 
possible,  not  too  short,  but  short  enough  to  prevent  their 
breaking.     The  skin  will  not  grow  over  them  more  than  it 


PERPLEXING  POINTS  IN  THE  NURSERY  ROUTINE    401 

should.  The  little  film  at  the  root  of  the  nail  is  not  harmful. 
When  the  child  is  older,  if  the  film  seems  unsightly,  it  is 
easily  removed. 

SUPPOSED   ADVANTAGES   OF   BEING 
THE   "MIDDLE   CHILD" 

I  have  just  seen  the  following  in  a  newspaper: 

"Mr.  George  Bancroft  accounted  for  his  own  longevity  with 
three  reasons:  First,  that  he  was  the  middle  child  in  his 
father's  family,  equally  distant  from  the  youngest  and  the 
oldest;  second,  that  he  had  always  gone  to  bed  at  ten  o'clock, 
unless  it  had  been  impossible;  and,  third,  that  he  had  always 
spent  four  hours  in  each  day  in  the  open  air,  unless  prevented 
by  a  storm.  He  added  that  his  riding,  of  which  the  newspa- 
pers had  made  so  much,  was  primarily  for  the  purpose  of  being 
out  of  doors,  and  not  of  being  on  horseback." 

The  early-to-bed  feature,  as  well  as  the  out-door  exercise,  need 
not  be  regarded  as  new;  but  this  is  the  first  time  I  have  ever 
heard  of  any  special  importance  being  attached  to  the  "middle 
child,"  and  would  like  very  much  to  learn  whether  there  is 
"anything  in  it."  Coming  from  any  less  authority  than  Mr. 
Bancroft,  I  should  have  set  it  down  as  superstition  and  thought 
nothing  further  of  it,  though  for  that  matter  I  cannot  say 
that  there  is  evidence  that  Mr.  Bancroft  really  did  say  it,  as 
the  above  quotation  was  itself  quoted  from  another  paper. 

We  have  never  heard  of  the  notion  before ;  we  believe  there 
is  ''nothing  in  it"  as  it  stands.  But  several  facts  may  have 
given  rise  to  the  belief,  if  such  belief  exists.  The  earlier 
children  of  immature  parents  sometimes  show  corresponding 
feebleness  of  constitution,  although  youth  of  the  parents,  if 
they  are  really  mature,  is  usually  considered  an  advantage 
to  the  offspring.  On  the  other  hand,  the  later  children,  if 
many  be  born  to  the  parents,  not  infrequently  show  the  ef- 
fects of  impaired  health  of  the  latter,  particularly  if  the 
mother's  condition  is  broken  by  constant  child-bearing  and  in- 
cessant nursery  care.  Still  further,  the  earlier  children,  it  is 
sad  to  say,  often  show  the  results  of  the  parents'  want  of^ 

26 


402  THE  CENTURY  BOOK  FOR  MOTHERS 

knowledge  and  bear  the  marks  of  their  experiments  in  child- 
rearing.  Not  infrequently  two  persons  of  little  experience  in 
anything,  but  of  the  "know-it-all"  type,  marry,  and  the  re- 
sult cannot  be  expected  to  be  perfect.  A  lady  once  half 
pathetically  said  to  the  writer,  when  speaking  of  her  first 
child:  "The  others  will  never  know  the  debt  they  owe  to 
him  for  teaching  me."  But  she  w^as  a  clever  w^oman,  anx- 
ious to  learn. 

UNJUSTIFIED   FEAR   OF   CONSUMPTION 

I  have  a  bright  little  girl  of  thirteen  months,  who,  with  the 
exception  of  a  slight  attack  of  whooping-cough,  from  which 
she  is  now  recovering,  has  always  been  strong  and  well.  I 
have  always  been  very  careful  about  her  digestion,  which  is 
perfect.  She  has  ten  teeth,  and  her  limbs  are  quite  sturdy. 
She  has  been  walking  since  she  was  eleven  months  old.  What 
troubles  me  about  her  is  that  there  has  been  consumption  in 
my  husband's  family,  his  mother  and  a  sister  having  died 
of  it.  He  is  himself,  although  well,  not  very  robust.  Should 
I  take  any  precautionary  measures  in  the  bringing  up  of  our 
daughter?  I  believe  in  fresh  air,  and  keep  her  outdoors  on 
pleasant  days  as  much  as  possible. 

Judging  from  all  you  say  as  to  the  condition  of  your  child, 
there  is  no  reason  for  worrying  or  taking  any  unusual  mea- 
sures in  her  bringing  up.  Do  not  trouble  yourself  on  account 
of  the  ancestral  consumption.  Do  your  best  to  keep  your 
child  in  good  condition,  and  do  not  anticipate  disease  of  any 
kind.  Of  course,  even  a  slight  ailment  should  not  be  neg- 
lected ;  but  as  she  has  begun  so  w^ell,  there  is  every  reason  to 
think  that  with  continued  care  she  will  develop  nicely.  Re- 
member that  consumption  can  come  only  from  infection,  and 
you  can  diminish  the  susceptibility  to  it. 

THE   DEFINITION   OF   NERVOUSNESS 

I  wish  you  would  define  the  meaning  of  "nervousness"  in  the 
medical  sense. 


PERPLEXING  POINTS  IN  THE  NURSERY  ROUTINE    403 

When  does  the  particular  condition  of  restlessness  which  is  so 
common  among  American  children  call  for  medical  interfer- 
ence, or  at  least  for  systonatic  care  on  the  part  of  the  mother  ? 

I  have  a  boy  of  six  who  is  certainly  excitable  and  not  particularly 
robust.  He  talks  in  his  sleep  and  tosses  about,  although  he 
rarely  awakes  during  the  night.  His  general  health,  however, 
is  perfect  as  far  as  I  can  tell.  He  has  begun  to  read,  and 
is  exceedingly  fond  of  his  primer.  Would  you  advise  sending 
such  a  child  to  a  kindergarten?  Some  of  my  acquaintances 
say  it  would  be  the  very  thing  to  quiet  his  restlessness,  others 
say  it  would  make  him  more  nervous.  Is  there  any  risk  in 
trying  ? 

Although  we  find  in  a  recent  medical  dictionary  the  follow- 
ing definition  of  nervousness,  '' excessive  excitability  of  the 
nervous  system,  especially  as  manifested  by  a  proneness  to 
mental  excitement  and  over-sensitiveness  to  sensory  impres- 
sions: the  condition  sometimes  borders  on  hysteria  or  in- 
sanity," yet  we  think  we  are  justified  in  saying  that  the 
word  is  a  popular  rather  than  a  medical  one.  It  is  not  much 
used  by  medical  men  when  speaking  with  precision,  other 
and  more  exact  terms  being  used  to  describe  various  mani- 
festations of  this  instability  of  the  nervous  system.  When 
used  in  the  general  sense  quoted  above,  its  application  is 
wide,  reaching  all  the  way  from  the  high-strung  person  who 
is  really  susceptible,  ordinarily  well,  self-controlled,  and 
capable  of  superb  exertion  on  need,  to  the  common  fidgety 
person,  the  pest  of  his  associates.  The  former  would,  per- 
haps, be  called  by  the  physician  a  neurotic  subject,  the  latter 
very  probably  a  hysterical  one.  So  you  see  we  cannot  give 
you  categorically  the  answer  you  desire. 

We  are  not  sure  that  we  can  assent  to  the  statement  that 
a  particular  condition  of  restlessness  is  very  common  among 
Americans  as  distinguished  from  others.  But  it  would  take 
us  too  far  to  discuss  this  point  now.  We  should  answer 
your  question  thus :  If  a  child  manifests  a  restlessness  which 
seems  to  the  parent  excessive,  the  advice  of  a  good  physician 
should  be  sought.     By  good  physician,  in  this  sense,  we  mean 


404  THE  CENTUEY  BOOK  FOR  MOTHERS 

one  of  some  experience  with,  children's  diseases  and  their 
developmental  peculiarities,  who  can  judge  wisely  whether 
the  restlessness  be  probably  dependent  upon  bad  hygiene,  such 
as  improper  food,  bad  sleeping  arrangements,  constipation, 
or  is  due  to  some  local  source  of  irritation,  of  which  defects 
of  vision,  skin  diseases,  pin-worms,  and  phimosis  are  exam- 
ples, or  again  to  simple  imperfect  nutrition  in  some  of  its 
many  forms.  The  object  of  his  search  will  be  to  assure  him- 
self whether  or  not  any  such  causes  can  be  found.  If  so, 
he  will  try  to  find  the  best  remedy ;  if  not,  he  will  advise  about 
domestic  care  and  training,  which  are,  after  all,  usually  the 
most  needed. 

As  to  your  own  child,  supposing  that  you  are  correct  in 
considering  his  general  health  perfect,  and  assuming  that 
this  nocturnal  restlessness  is  of  recent  appearance,  the  first 
thing  we  should  think  of  would  be  the  irritation  of  the  ''six- 
year-old  molars,"  which  may  be  coming.  Next,  we  should 
inquire  into  his  dietary,  and  especially  as  to  his  evening  meal, 
and  should  examine  as  to  the  existence  of  phimosis.  In  any 
event,  we  do  not  think  that  a  well-conducted  kindergarten 
could  do  him  harm,  and,  if  the  nervousness  is  not  excited 
by  any  recognizable  and  removable  cause,  it  would  probably 
be  of  advantage  to  him. 

WASHING   THE   INFANT'S   MOUTH 

Should  an  infant's  mouth  be  washed  before  he  is  six  weeks  old? 
I  heard  of  a  case  where  the  child's  mouth  was  not  washed  from 
the  time  of  birth,  and  I  thought  it  conducive  to  thrush,  sprue, 
or  a  soreness  of  the  mouth. 

It  is  best  to  wash  the  mouth  after  every  nursing  or  feeding 
from  the  first,  especially  if  the  bottle  is  used. 

THE   GIVING   OF   AN   ENEMA 

What  is  the  best  way  of  giving  an  enema  to  a  child?  How 
much  fluid  should  be  given  to  a  child  of  six  weeks,  and  how 


PERPLEXING  POINTS  IN   THE   NURSERY  ROUTINE    405 

much  to  one  of  two  years?  Should  oil,  salt,  or  soap  be  used 
in  all  cases?  What  is  the  best  syringe  for  children?  How 
much  oil  should  be  used  in  proportion  to  the  water?  How 
long  should  the  fluid  be  retained  before  the  child  is  put  on 
the  chair?  Any  general  directions  about  the  giving  of  an 
enema  will  be  greatly  appreciated. 

The  best  syringe  for  children  is  one  of  hard  rubber,  with  a 
long,  smooth  nozzle,  and  having  a  capacity  of  six  fluid  ounces. 
When  oil  alone  is  injected,  a  relatively  small  quantity  is 
used,  and  the  intention  is  to  have  it  remain  in  the  intestines 
and  act  mechanically  on  the  feces;  its  retention  is  best  se- 
cured by  firmly  pressing  a  warmed  pad  of  flannel  against 
the  seat  for  five  minutes  after  the  insertion,  the  child  in 
the  meanwhile  lying  upon  its  back.  An  enema  of  water 
may  be  presently  used  if  necessary.  The  laxative  enemata 
must  vary  in  bulk  with  the  age  of  the  child,  or,  in  other 
words,  with  the  capacity  of  the  rectum.  One  fluid  ounce 
(two  tablespoonfuls)  will  be  sufficient  for  an  infant  of  six 
weeks,  while  from  four  to  six  fluid  ounces  are  required  at 
the  age  of  two  years.  The  quantity  of  oil,  salt,  or  soap  to 
be  used  must  depend  upon  the  quantity  of  water— two  tea- 
spoonfuls  of  oil  or  one  teaspoonful  of  salt  to  eight  table- 
spoonfuls  of  water  being  a  good  proportion,  and  if  soap  be 
employed  it  is  sufficient  to  stir  a  bit  in  the  water  until  suds 
begin  to  form.  After  drawing  the  fluid,  which  must  be 
tepid,  into  the  syringe,  the  nozzle  must  be  well  greased  and 
gently  inserted  into  the  seat,  the  point  being  directed  a  little 
toward  the  child's  left ;  next,  the  piston  is  to  be  slowly  forced 
down  until  all  the  liquid  is  expelled  or  complaints  of  pain 
indicate  that  the  bowel  is  sufficiently  distended.  If  it  be 
possible  to  force  retention  for  a  moment  or  two  by  pres- 
sure on  the  seat,  the  movement  will  be  freer  and  easier 
than  if  the  fluid  be  allowed  to  flow  away  at  once.  The 
best  position  for  the  child  is  either  on  his  back  with  the 
legs  well  drawn  up  or  resting  on  his  abdomen  across 
the  lap. 


406       THE  CENTURY  BOOK  FOR  MOTHERS 

THE  MUSTARD-PLASTER 

Can  you  tell  me  how  to  prepare  a  mustard-plaster  for  a  child? 
How  long  should  it  be  allowed  to  remain  on  the  skin?  Can 
the  plaster  be  put  next  to  the  skin?  Is  mustard-paper  of  any 
value  ? 

A  mustard-plaster  for  a  child  should  be  made  of  white  in 
preference  to  black  mustard,  as  the  latter  has  nearly  twice 
the  strength  of  the  former.  For  a  patient  between  one  and 
three  years  old,  one  part  mustard  and  two  parts  Indian-meal 
or  flour  are  to  be  mixed  with  lukewarm  Avater— care  being 
taken  not  to  make  it  too  thin— and  spread  between  two  folds 
of  thin  muslin,  as  a  poultice  is  spread,  only  in  a  very  much 
thinner  layer.  This  may  be  allowed  to  remain  on  for  from 
fifteen  to  thirty  minutes,  or  until  the  skin  is  reddened  or  the 
child  complains  of  its  burning.  Under  one  year  the  propor- 
tions should  be  one  of  mustard  to  three  or  four  of  flour,  and 
for  children  of  over  three  years  equal  parts  may  be  used. 
Never  apply  the  mustard  directly  to  the  skin,  as  some  of  it 
may  escape  being  washed  off  and  give  rise  to  a  blister.  Mus- 
tard-paper consists  of  black  mustard  mixed  with  a  solution 
of  gutta-percha  and  spread  on  pieces  of  stiff  paper  about 
four  inches  square,  which,  when  moistened,  are  ready  for 
use.  These  sinapisms  are  very  convenient  for  travelers,  but 
their  action  is  often  rather  severe,  and  they  are  not  to  be 
recommended  for  children. 

If  a  child  is  very  young  or  unconscious,  the  plaster  should 
be  carefully  watched,  for  fear  of  too  great  irritation  of  the 
skin,  a  mustard  blister  making  a  very  intractable  sore. 

KISSING   BY   FORCE 

I  believe  it  is  high  time  for  mothers  to  organize  an  anti-kissing 
club,  at  least  so  far  as  their  babies  are  concerned.  The  mat- 
ter is  brought  home  to  me  almost  daily,  owing  to  the  fact  that 
I  have  what  one  fond  relative  calls  the  most  "kissable"  baby 
in  town.     The  poor  child  is  kissed  and  hugged  almost  to  death. 


PERPLEXING  POINTS  IN  THE  NURSERY  ROUTINE    407 

certainly  to  the  point  of  nervous  restlessness.  And  then,  it 
seems  to  me  there  is  the  danger  of  communicating  some  throat 
trouble.  But  one  of  my  friends  thinks  that  children  ought  to 
be  trained  early  to  be  friendly,  and  that  it  is  not  wise  to  keep 
them  away  from  fond  visitors.  I  wish  you  would  publish 
some  remarks  on  the  subject,  so  that  I  may  reinforce  my  pro- 
test by  the  weight  of  your  authority. 

The  promiscuous  kissing  of  children  is  certainly  to  be  depre- 
cated on  various  grounds.  Many  persons,  in  their  affection- 
ate zeal  to  kiss  a  child,  do  not  stop  to  consider  whether  they 
are  themselves  pleasant  persons  to  kiss,  and  older  children 
often  feel  a  strong  sense  of  resentment  when  kissed  against 
their  will.  The  contagious  disorders  of  mouth  and  throat 
can  be,  and  probably  often  are,  communicated  in  this  way. 
They  certainly  are  in  adults.  The  breath  of  persons  suffer- 
ing from  whooping-cough,  measles,  and  scarlatina  is  univer- 
sally dreaded;  but,  excepting  the  first  named,  and  more 
rarely  in  the  first  stages  of  the  others,  owing  to  the  isolation 
of  the  patients,  these  diseases  are  probably  not  often  spread  in 
this  way.  The  danger,  we  believe,  is  especially  great  in 
connection  with  the  various  kinds  of  sore  throat,  and  no  one 
with  a  sore  throat,  however  slight,  should  kiss  a  child.  But 
even  a  well  person  should  consider  whether  his  affection  for 
a  pretty  child  ought  to  be  expressed  in  a  way  which  may  be 
distasteful  to  the  child  and  not  approved  of  by  the  mother.  It 
is  easy  enough  to  show  our  tenderness  by  some  caress  which 
cannot  harm.  Certainly  no  child  ought  to  be  made  to  kiss 
any  one  against  its  will.  Proverbially,  ''kissing  goes  by 
favor, ' '  and  it  is  foolish  to  make  an  act  which  is  universally 
accepted  as  an  expression  of  hearty  good  will  seem  to  a  child 
disciplinary. 


XXV 
FEEDING  PROBLEMS 

THE   SELECTION   OF   A   WET-NURSE 

The  evils  and  dangers  of  intrusting  one's  delicate  child  to  a 
stranger  are  no  doubt  great;  but,  after  all,  in  many  cases  th3y 
must  be  bravely  met  in  order  to  save  the  very  life  of  the  child. 
Artificial  nourishment  is  at  best  only  a  makeshift.  I  tried  it 
once,  in  the  case  of  my  second  child,  but  determined  never  to 
bring  up  another  child  on  the  bottle  as  long  as  I  was  able  to 
pay  for  a  wet-nurse  and  bear  up  physically  under  the  inevitable 
annoyances  in  her  train.  But  not  many  mothers  can  bespeak 
a  wet-nurse  in  advance,  and  in  the  hurry  of  procuring  one  in 
the  hour  of  need  it  is  almost  impossible  to  exercise  the  care 
and  discretion  that  are  so  essential  in  the  selection  of  the 
proper  person.  Nor  is  a  physician's  advice  always  available. 
I  have  often  wished  to  be  informed  concerning  the  physical 
qualifications  of  a  wet-nurse,  but  have  never  found  anything 
really  useful  in  popular  books  or  periodicals.  It  would  seem 
superfluous  to  look  for  even  average  mental  or  moral  quali- 
fications in  persons  of  the  class  that  furnishes  wet-nurses,  and 
I  know  that  many  excellent  persons  object  to  employing  them 
under  any  circumstances  whatever.  But  those  who  do  em- 
ploy them  need  enlightenment.  Perhaps  you  could  furnish 
what  I  have  vainly  looked  for  elsewhere. 

Before  speaking  of  the  qualifications  of  a  wet-nurse,  a  word 
ought  to  be  said  as  to  the  duty  of  the  mother  who  is  obliged 
to  give  up  the  suckling  of  her  own  child.  It  has  been  in 
effect  said  by  another  that  any  one  who  takes  the  responsi- 

408 


FEEDING  PROBLEMS  409 

bility  of  bearing  a  child  is  bound  to  furnish  its  food  from 
her  own  breast,  or  to  superintend  herself  the  feeding  of  it  if 
she  cannot  nurse  it.  Exceptions  will  occur,  as  when  the 
mother 's  health  absolutely  disables  her ;  but  the  rule  will 
stand.  It  would  seem  as  if  this  would  need  no  insistence, 
but  it  is  a  matter  of  daily  observation  that  there  are  many 
mothers  who  will  hardly  trust  the  house-maid  to  dust  the 
bric-a-brac,  who  insist  on  personally  laying  out  the  changes 
of  bed-linen  and  dispensing  the  groceries,  and  yet  who  never 
think  of  inspecting,  except  perhaps  at  rare  intervals,  the 
method  in  which  the  baby's  food  is  prepared.  Further,  it  is 
proper  to  say  that  good  artificial  feeding  is  scarcely  any  more 
a  makeshift  than  most  wet-nursing. 

Now,  if  a  wet-nurse  is  procured  a  similar  supervision 
should  be  exercised  as  over  the  dry-nurse.  As  wet-nurses 
are  not  selected  from  the  highly  intelligent  classes,  it  is  not 
to  be  expected  that,  without  experience,  they  will  be  very 
handy  and  tactful  with  a  baby ;  and  an  experienced  wet-nurse 
is  not  usually  desirable,  inasmuch  as  young  women  have,  as 
a  rule,  the  best  breasts,  and  experience  and  youth  do  not 
go  together.  The  mother  must  do  the  watching,  and  remem- 
ber that  the  nurse  has  been  chosen  for  the  one  physical 
quality  of  a  good  breast  of  milk.  If  she  is  not  handy  with 
the  baby  she  is  usually  very  glad  to  learn  if  she  is  kindly 
taught. 

A  common  complaint  is  that  wet-nurses  are  tyrannical, 
demanding  stimulants  and  various  luxuries  for  the  sake  of 
the  milk,  and  threatening  to  desert  the  baby  if  their  de- 
mands are  not  granted.  Occasionally  a  distinctly  vicious 
woman  goes  out  as  a  wet-nurse,  but  as  a  rule  they  are  nei- 
ther better  nor  worse  than  other  women  in  their  rank  of  life, 
and  come  with  an  honest  intent  to  do  their  duty.  On  the 
whole,  they  are  amenable  to  intelligent  treatment.  If  they 
prove  to  be  tyrants  it  is  because  of  want  of  sense  on  the  part 
of  their  employers.  In  engaging  a  wet-nurse,  she  should  be 
made  to  feel,  if  possible,  that  she  has  an  interest  in  common 
with  her  employer;  that  the  employer  is  desirous  of  doing 


410  THE  CENTURY  BOOK  FOR  MOTHERS 

what  is  best  for  her  health  and  comfort,  because  by  so  doing 
the  welfare  of  the  child  is  best  secured.  Moreover,  she 
should  understand  that  it  is  for  her  interest  faithfully  to 
attend  to  her  duties ;  that  no  trifling  with  her  own  digestion 
and  health  will  be  tolerated ;  and  that,  while  she  will  be 
valued  in  proportion  as  the  child  thrives,  she  will  not  be 
kept  for  a  day  if  she  neglects  its  interests.  Let  her  under- 
stand that,  while  you  desire  breast  milk  if  it  is  good,  you 
much  prefer  artificial  feeding  to  poor  breast  milk.  If  these 
things  are  clearly  and  kindly  impressed  upon  her  there  is 
little  probability  of  her  playing  false.  The  other  method, 
too  often  seen,  is  to  make  a  sort  of  pet  of  the  wet-nurse  for  a 
while,  to  foolishly  coddle  her  in  all  ways,  until  she  is  per- 
suaded that  she  is  indispensable ;  and  then,  unless  she  is  a 
person  of  unusual  judgment,  she  is  spoiled,  and  the  employer 
reaps  the  harvest  of  her  own  folly,  and  considers  the  nurse  a 
most  ungrateful,  if  not  an  inhuman,  creature. 

The  choice  of  a  wet-nurse  should  not  be  made  without  a 
careful  medical  examination ;  the  risk  is  too  great.  The  em- 
ployer may  ascertain  points  as  to  the  character  of  the  nurse, 
and  may  perhaps  get  information  regarding  her  previous 
health  and  the  health  of  her  child  or  children.  But,  after 
all,  the  burden  of  the  examination  is  medical,  and  cannot  be 
properly  assumed  without  professional  knowledge.  And  for 
the  physician  it  is  an  unenviable  office.  Not  only  must  he 
find  out  the  condition  of  the  breast  and  the  supply  of  milk 
and  its  probable  continuance,  but  he  must  search  with  the 
greatest  care  for  diseases  or  defects.  And  in  this  search  he 
is  never  helped  by  the  person  examined;  she  usually  has  no 
knowledge  of  the  meaning  of  symptoms,  and  she  lays  no 
stress  upon  many  things  which  the  examiner  would  consider 
fatal  objections.  If  she  has  knowledge  of  defects,  in  her  de- 
sire for  employment  she  would  not  obtrude  them.  The  de- 
tails of  the  medical  examination  it  would  be  useless  to  give 
here.  The  physician  also  endeavors  to  distinguish  between 
the  appearances  due  to  ill  health  and  those  due  to  poverty, 
want,  and  perhaps  even  hunger,  or  to  distress  at  the  pros- 


FEEDING  PROBLEMS  411 

pect  before  the  nurse  of  leaving  her  own  child,  for  which 
she— and  often  with  good  reason— fears  the  worst. 

CAN   THE   NURSE'S   OR   MOTHER'S   MILK 
BE   POISONOUS? 

I  read  once  of  nurse's  milk  (I  suppose  it  means  mother's,  too) 
sometimes  being  too  "poor,  or  so  poisonous  as  to  be  useless." 
I  wish  to  learn  the  cause  or  causes  of  this,  and  how  one  can 
know  it,  so  as  not  to  injure  the  infant. 

The  milk  of  a  nurse  or  mother  is  rarely  poisonous  in  the  sense 
of  producing  any  sudden  illness.  Rare  cases  of  such  effects 
have  been  reported  in  which  the  change  in  the  milk  followed 
fright,  anger,  or  some  \iolent  emotion  on  the  part  of  the 
mother  or  nurse.  Milk  usually  disagrees  by  causing  bowel 
troubles,  or  more  commonly  by  being  too  poor  in  quality,  so 
that  the  child  is  not  properly  nourished,  and  after  a  while 
shows  that  it  is  not.  Unfortunately,  in  this  last,  and  the 
commonest,  class  of  cases  there  is  no  sure  way  of  judging, 
except  by  constant  observation  of  the  child  to  see  if  it  is 
thriving— i.  e.,  gaining  weight,  however  slowly,  keeping  its 
firmness  of  flesh,  its  color,  etc. 

THE   FLOW   OF   MILK   THE    FIRST   DAYS 
AFTER   DELIVERY 

Will  you  please  tell  what  is  best  to  be  done  on  the  two  dreadful 
days  after  birth,  "before  the  milk  comes"?  If  there  is  to  be 
none,  would  it  not  be  as  well  to  feed  the  child  at  once?  Why 
is  there  such  a  break  in  an  infant's  nourishment? 

Those  days  are  not  always  ''dreadful";  indeed,  we  think 
they  rarely  are  so  in  this  day  of  good  nursing.  That  the  ab- 
sence of  the  milk  is  not  a  detriment  to  the  baby  may  be  in- 
ferred from  the  fact  that  most  living  things  in  nature  are 
adapted  to  their  surroundings,  and  also  from  the  foilomng 
facts:  Not  only  infants  but  all  young  mammals  pause  in 


412  THE  CENTURY  BOOK  FOR  MOTHERS 

their  growth  for  a  few  days,  perhaps  for  a  week,  after  their 
birth,  and  they  may  absolutely  lose  weight.  A  similar  delay 
is  noticed  in  newly  hatched  chickens,  which,  of  course,  never 
depend  upon  the  mother  for  food.  The  experiment  has  been 
tried,  in  a  series  of  cases,  of  putting  new-born  infants  to 
the  breasts  of  women  who  had  been  delivered  a  few  days 
previously  and  whose  flow  of  milk  Avas  established.  These 
children  all  lost  weight  like  others.  The  cause  of  this  loss  is 
not  certainly  known,  but  is  believed  to  be  due  to  the  fact  of 
the  establishment  of  respiration  and  the  necessity  of  the 
child's  furnishing  its  own  heat  instead  of  getting  it  from  its 
mother.  More  tissue  is  burned  up  until  the  new  order  is 
established.  Besides,  the  intestinal  canal  is  emptied  of  a  con- 
siderable amount  of  gradually  accumulated  matter.  If  dur- 
ing those  days  the  child  is  kept  warm  and  its  thirst  quenched 
with  warm  liquid,  it  generally  makes  little  complaint. 


GOAT'S   MILK   AND   ASS'S   MILK 

Are  goat's  milk   and   ass's  milk   ever   prescribed   for   children? 
How  does  such  milk  differ  from  cow's  milk  ? 


Both  have  been  given,  but  rarely  in  this  country.  Goat's 
milk  is  fatter  than  cow's  milk.  Its  smell  is  disagreeable  to 
many,  and  it  has  no  advantages  over  cow's  milk.  The  milk 
of  the  ass  has  less  fat  and  proteids  and  more  sugar  than  cow 's 
milk,  and  is  in  these,  as  well  as  in  some  other  peculiarities, 
intermediate  between  cow's  milk  and  human  milk.  It  has 
been  considerably  used  upon  the  Continent.  Mare's  milk  is 
much  like  ass's  milk. 


TESTING   THE   QUALITY   OF   BREAST   MILK 

How  rich  should  breast  milk  be?  That  is,  if  drawn  and  placed 
in  a  bottle  to  the  depth  of  two  inches,  how  much  should  the 
cream  measure? 


FEEDING  PROBLEMS  413 

If  you  let  it  stand  in  a  room  of  ordinary  temperature  twen- 
ty-four hours  the  cream  should  be  on  an  average  nearly  one 
eighth  of  the  whole,  say  a  quarter  of  an  inch  in  two  inches. 
Variation  between  one  tenth  and  one  fifth  may  exist  in  milk 
upon  w^hich  the  mother's  infant  thrives,  but  the  average  is  as 
stated.  A  test  tube  with  a  rubber  cork,  which  may  be  ob- 
tained at  the  apothecary 's  shop,  is  a  more  convenient  appara- 
tus than  a  bottle  for  testing.  But  this  testing  by  eye  must 
not  be  considered  as  absolute. 


OBJECTIONS   TO   GIVING    BREAST   MILK   BY   SPOON 

would  like  your  opinion  on  the  practice  of  drawing  mother^s 
milk  at  one  nursing,  and  feeding  it  to  the  baby  by  spoon  or 
bottle  for  the  next.  Is  it  as  good  for  the  baby?  And  does  it 
remain  unchanged  by  standing  and  being  warmed? 


For  various  reasons,  it  is  not  a  good  plan.  Not  to  mention 
other  objections,  the  milk  is  no  longer  the  sterile  liquid  w^hich 
it  probably  was,  or  nearly  so,  when  it  came  from  the  breast. 


BOTTLE   VERSUS   SPOON 

Do  you  think  that  a  little  baby  could  be  fed  as  satisfactorily  by 
spoon  as  by  bottle  once  a  day?  I  dislike  bottles,  and  never 
used  one  when  I  weaned  my  first  baby  at  ten  months,  but  do 
not  know  whether  a  spoon  would  be  too  fatiguing  for  a  three- 
months'  baby. 

We  prefer  the  bottle  if  kept  clean.  The  only  circum- 
stances under  which  we  prefer  the  cup  and  spoon  are  w^hen 
we  think  the  attendant  will  keep  them  clean  and  cannot 
be  made  to  keep  a  bottle  and  nipple  clean.  A  child  of 
ten  months  is  no  longer  "a  little  baby"  as  nurses  use  the 
phrase. 


414       THE  CENTURY  BOOK  FOR  MOTHERS 


"SUCKING  WIND" 

Is  it  possible  for  a  baby  to  "suck  wind"  into  its  stomach  from  a 
nursing-bottle?  I  had  always  accepted  it  as  an  unquestioned 
fact  until,  in  a  recent  number  of  a  periodical,  I  noticed  that 
the  idea  was  ridiculed.  Nurses  and  mothers  might  be  re- 
lieved of  considerable  anxiety  in  this  matter  if  it  could  be 
shown  that  "sucking  wind"  is  only  an  "old-woman's  whim," 
as  alleged  by  the  writer  of  that  article. 

There  is  nothing  ridiculous  in  the  supposition  that  a  child 
may  ''suck  wind"  from  a  nursing-bottle  improperly  man- 
aged. Cases  of  air-swallowing  by  adults  are  cited  in  works 
on  medicine.  The  celebrated  French  physiologist  Magendie 
made  extended  researches  on  this  point.  He  found  that 
many  persons  had  the  power  of  swallowing  air,  and  he 
learned  to  do  it  himself,  but  gave  up  the  practice  owing  to 
the  distress  it  caused  him.  "Wind-sucking"  is  a  familiar 
enough  vice  in  horses.  There  is,  therefore,  nothing  ridicu- 
lous in  supposing  that  a  baby  mth  good  sucking  power  might 
swallow  air.  How  far  infants  actually  do  so  is  another  mat- 
ter; the  distinction  between  a  colic  from  swallowing  of  air 
and  one  from  gaseous  indigestion  can  be  made  only  after 
patient  watching  of  the  symptoms.  The  rule  should  be: 
Manage  the  bottle  so  that  the  baby  cannot  get  air  from  it. 


COMBINED   NURSING   AND   BOTTLE-FEEDING 
AT   ONE   MEAL 

Do  you  think  nursing  and  bottle-feeding  together  at  the  same 
meal  bad  for  a  baby  ? 

We  do  not  like  it,  not  so  much  because  of  the  mixing  of  the 
two  kinds  of  nourishment,  as  because,  if  the  breast  is  not 
equal  to  the  total  feeding,  it  ought  to  have  the  needed  rest. 
Further,  the  child  contracts  a  bad  habit  of  wanting  the  breast 


FEEDING  PROBLEMS  415 

with  artificial  food,  and  weaning  becomes  difficult.  Still 
further,  it  is  impossible  to  know  just  how  much  a  child  is 
taking  when  this  confused  method  is  employed. 


THE   SIGNS   OF   INSUFFICIENT   BREAST   MILK 

I  have  so  frequently  seen  it  stated  that  few  mothers  have  breast 
milk  of  sufficient  quantity  and  quality  for  a  baby  of  eleven  or 
twelve  months,  that  I  should  like  to  inquire  what  are  the  in- 
dications that  a  baby  needs  more  nourishment  than  the  breast, 
and  whether  you  approve  of  changing  to  artificial  food  by  de- 
grees, giving  one  bottle  a  day  for  a  month  or  two,  perhaps,  and 
slowly  adding  more.  I  have  been  taught  that  a  baby  during 
the  first  months  of  its  life  should  gain  one  half-pound  a  week 
in  weight.  How  long  should  this  gain  keep  up,  and  does  a 
sudden  lessening  of  the  gain  indicate  that  the  breast  is  not  sat- 
isfying, and  what  other  food  is  required? 

The  signs  that  the  milk  of  a  breast  is  no  longer  equal  (either 
in  quantity  or  quality,  or  in  both)  to  the  needs  of  the  child 
are  a  diminution  of  increase  in  weight,  softness  of  flesh,  pale- 
ness, clamor  for  more  prolonged  or  more  frequent  sucklings, 
and  the  like.  During  the  early  months  a  gain  of  half  a 
pound  a  week  may  be  accepted  as  evidence  of  decidedly  good 
nutrition,  provided  the  flesh  be  firm  and  the  color  good. 
After  five  or  six  months  as  much  as  this  can  hardly  be  ex- 
pected. The  gain  will  be  less  and  vary  somewhat.  But  a 
sudden,  material  lessening  of  the  rate  of  gain  should  always 
be  looked  upon  with  suspicion,  and  if  it  persists  more  than  a 
week  or  two  the  condition  of  the  breast  should  be  investi- 
gated, and  usually  a  need  of  additional  food  will  be  discov- 
ered. We  approve  of  the  gradual  method  of  increasing  the 
food,  provided  it  appears  that  the  breast  is  still  valuable  to 
a  considerable  degree.  Often  it  proves  of  so  little  value  that 
rapid  substitution  of  artificial  food  is  necessary,  the  breast 
serving  only  to  amuse  or  quiet  the  child  at  night. 


416  THE  CENTURY  BOOK  FOR  MOTHERS 

NURSING   ANOTHER  BABY  IN  ADDITION  TO  ONE'S   OWN 

Is  there  any  harm  in  nursing  a  baby  four  months  old  (with 
whom  no  food  agrees,  its  own  mother  having  no  milk)  when 
one's  own  baby  is  but  a  few  days  old?  Is  the  difference  in 
ages  too  great,  and  will  the  young  baby  suffer?  If  there  is 
harm  in  so  doing,  please  state  how. 

As  a  rule,  the  new  breast  agrees  x^erfectly  well  with  the  older 
child,  unless  it  has  some  form  of  digestive  trouble  which 
forbids  the  use  of  any  kind  of  milk.  On  the  other  hand,  we 
do  not  know  whether  the  new  babe  is  to  get  enough  from  the 
breast.  The  new  one  ought  certainly  to  have  the  first  chance, 
and  the  visitor  should  come  in  for  what  is  left.  Besides, 
extra  care  of  the  nipples  is  necessary  when  one  suckles  a  baby 
who  is  not  well,  and  care  of  the  mouth  of  the  sick  baby  is 
also  necessary.  The  disadvantages  in  the  case  seem  to  be  on 
the  side  of  the  new  baby,  who  is  the  proper  owner  of  the 
breast. 


THE   SUPPLY   OF   BREAST  MILK   AS   COMPARED   WITH 
THE   ALLOWANCE   OF    BOTTLE-FED   BABIES 

How  many  ounces  of  milk  should  a  six-months-old  baby  be 
allowed  to  have  at  a  feeding  ?  I  have  been  told  six  ounces,  but 
as  that  never  seems  to  satisfy  her,  I  have  been  giving  her  be- 
tween seven  and  eight.  She  has  seven  meals  in  twenty-four 
hours.  Breast-fed  babies  nurse  till  they  are  satisfied;  why 
not  let  bottle  babies  do  the  same?  Why  are  they  limited  to  a 
certain  number  of  ounces  while  breast  babies  have  an  un- 
limited supply? 

The  amount  at  six  months  varies  a  little  with  different  babies. 
Six  would  be  an  average  demand,  seven  a  large  amount. 
But  only  six  meals  are  proposed  on  this  basis.  Your  child 
at  six  months  is  getting  between  seven  and  eight  ounces  seven 
times  a  day;  that  is  between  forty-nine  and  fifty-six  ounces 
daily— a  pretty  heavy  allowance  of  food,  even  if  properly 


FEEDING  PROBLEMS  417 

diluted,  for  a  child  of  one  year.  You  say  ' '  of  milk, ' '  but  Ave 
assume  that  you  mean  diluted  milk. 

Your  assumptions  about  nursing  babies  are  wrong.  If 
you  were  to  weigh  one  before  and  after  nursing,  you  would 
find  that  almost  never  does  one  get  as  much  liquid  as  your 
child  gets.  The  breast  milk  is  far  from  ''an  unlimited  sup- 
ply." The  amount  recommended  for  artificial  feeding  is 
based  upon  accurate  observations  of  nursing  babies.  Why 
your  baby  is  not  satisfied  we  do  not  know.  Very  possibly 
from  an  over-distension  of  the  stomach  and  overtaxing  of 
digestion. 

EVILS   OF   EARLY   MIXED   FEEDING;    EFFECT   OF  THE 
MOTHER'S   DIET   UPON   THE   CHILD'S   TEETHING 

Should  a  child  from  three  to  five  months  old  be  fed  at  all  at  the 
table  when  there  is  a  sufficiency  of  mother's  milk?  If  so,  what 
should  it  be  given?  My  babe,  now  five  months  old,  seems  to 
delight  in  eating,  and,  as  I  think  I  have  enough  milk  for  her,  I 
hesitate  in  giving  her  solid  foods,  though  I  am  advised  to  feed 
her  by  ladies  who  feed  and  also  nurse  their  babies  with  no  ap- 
parently bad  results.  My  baby  is  troubled  with  constipation 
and  I  am  told  that  feeding  her  will  overcome  it. 

Is  it  right  and  proper  to  "chew"  food  for  babies? 

Cannot  a  mother  that  suckles  her  babe  hasten  or  retard  its 
teething  by  selecting  her  diet;  i.  e.,  if  early  development  of 
teeth  is  wanted,  partake  of  bone-making  foods,  and  vice  versa? 

A  child  should  have  nothing  whatever  from  the  adult  table 
before  a  year  and  a  half  at  the  earliest,  preferably  not  until 
two  years.  Solid  food  should  not  be  allowed  until  after  a 
year,  and  then  it  should  be  bread,  gruels,  porridge,  and  pos- 
sibly an  egg;  but  these  should  be  prepared  for  it  and  given 
it  by  itself,  not  at  the  adults'  table.  To  let  a  child  come  to 
the  table  is  only  to  teach  it  to  beg  for  things  it  should  not 
have.  Let  it  be  fed  before  your  meals,  so  that  it  shall  not 
be  tantalized  at  seeing  you  eat  when  it  is  hungry.  Treat  any 
person  who  gives  your  baby  "tastes"   of  things  as  your 

27 


418        THE  CENTURY  BOOK  FOR  MOTHERS 

''dearest  foe."  To  give  solid  food  to  a  child  on  the  breast 
is  too  incongruous  to  be  seriously  considered.  Constipation 
is  undesirable,  but  a  small  matter  compared  with  what  usu- 
ally results  from  such  mixed  feeding. 

If  you  mean  the  chewing  of  food  by  an  adult  and  then 
putting  it  into  the  baby's  mouth,  it  certainly  is  not  right. 
It  is  simply  disgusting. 

Good  health  and  good  milk-supply  in  the  mother  help  to 
develop  the  child  well  and  rapidly,  teeth  included.  But  so 
far  as  we  know  or  believe,  there  is  no  diet  of  the  mother 
which  will  help  the  teeth  of  the  child  in  particular.  The 
only  way  of  retarding  the  teeth  that  we  know  of  is  to  give  the 
baby  poor  nourishment,  and  this  retards  its  development  in 
every  other  way. 

FEEDING   AT   NIGHT   AFTER  WEANING 

My  boy  is  now  nine  months  old,  and  gets  all  his  nourishment 
from  the  breast.  I  am  very  particular  about  my  diet,  eat  oat- 
meal, milk,  eggs,  fruit,  etc.  He  is  nursed  once  in  three  hours, 
night  and  day.  Shall  I  feed  him  in  the  night,  after  he  is 
weaned,  and  if  so,  how  often  ? 

If  you  have  not  diminished  the  frequency  of  nursing  before 
you  begin  to  wean  the  boy,  you  will  have  quite  an  under- 
taking before  you;  for  if  you  have  to  prepare  food  every 
three  hours,  night  and  day,  your  sleep  will  be  badly  broken. 
It  may  be,  however,  that  his  frequent  demands  for  food  are 
due  to  the  fact  that  the  breast  milk  is  now  deficient  in  quan- 
tity or  quality,  so  that  he  is  not  properly  fed,  and  if  he  gets 
a  full  supply  of  food  at  one  time  he  may  be  content  for  a 
longer  time.  Try  to  alternate  the  food  with  the  breast;  let 
him  take  a  good  bottleful  of  the  food,  and  then  lengthen  the 
interval  after  it.  We  fear  that  your  habit  of  too  frequent 
nursing  will  prevent  your  cutting  him  off  altogether  at  night 
at  first,  but  a  child  as  old  as  he  ought  to  go  at  least  six  hours 
without  food  at  night.  If  he  is  fed  at  the  parents'  bedtime 
he  ought  to  need  no  food  till  toward  morning. 


FEEDING  PROBLEMS  419 

THE   TESTS   OF    RICH   MILK 

I  live  in  a  part  of  the  country  which  is  noted  for  the  excellence 
of  its  milk-supply,  yet  I  have  my  doubts  about  the  quality  of 
the  particular  milk  which  is  furnished  me.  It  somehow  has 
not  the  rich  flavor  to  which  I  am  accustomed,  and  looks  rather 
thin.  My  purveyor  is  a  well-to-do  farmer,  who  supplies  me 
with  the  choicest  vegetables,  and  I  don't  like  to  suspect  his  hon- 
esty as  to  the  milk  without  good  cause.  Is  there  any  way  by 
which  one  can  positively  tell  whether  milk  is  skimmed  or  not? 

You  can  set  some  of  the  milk  to  raise  the  cream  in  a  straight- 
sided  test-tube,  and  guess  by  eye  the  percentage  of  cream. 
Or  you  can  get  an  ordinary  druggist's  graduated  glass,  or 
even  one  of  the  bottles  in  which  milk  is  sold,  upon  which  a 
mark  is  blown  to  indicate  the  point  to  which  the  cream  after 
rising  should  reach  down.  This  will  not  positively  tell  you 
whether  or  not  the  milk  has  been  skimmed,  but  it  will  tell 
you  whether  or  not  it  still  contains  cream  of  the  standard 
amount. 

SCUM   ON   BOILED   MILK 

Will  you  tell  me  what  part  of  the  milk  rises  to  form  the  scum 
on  the  top  when  boiled,  and  whether  it  should  be  removed  or 
stirred  in  before  feeding  to  a  child? 

We  do  not  remember  to  have  ever  seen  a  chemical  analysis 
of  this  scum,  but  suppose  that  it  is  chiefly  the  milk  albumen, 
and  probably  some  fat  mechanically  mixed  with  it  by  the 
boiling.  Whether  it  is  to  be  rejected  or  not  is  a  question  of 
palate.     Personally,  we  throw  it  out. 


A  WARNING   AGAINST   SOUR   MILK 

Can  you  tell  me  what  to  do  when  the  milk  sours  with  which  I 
have  to  feed  my  eight-months-old  child?  My  milkman  comes 
at  night,  and  on  one  or  two  occasions  the  milk  has  been  sour  at 
the  two-o'clock  meal  the  next  day.     What  can  I  give  my  child 


420       THE  CENTURY  BOOK  FOR  MOTHERS 

as  a  substitute  when  this  occurs?  It  troubles  me  when  I 
try  to  think  of  what  I  should  do  in  case  of  not  having  any 
milk. 
The  milk  I  get  is  usually  very  good,  and  the  man  who  brings  it 
says  the  souring  is  caused  by  some  cows  going  dry.  Ought 
such  milk  to  be  used? 

Under  no  circumstances  should  sour  milk  be  given.  During 
hot  weather  it  is  better  to  attend  to  the  preparing  of  food 
and  sterilizing  of  milk  as  soon  as  the  latter  is  received.  In 
case  of  milk  souring,  if  sweet  milk  cannot  be  had,  we  should 
use  condensed  milk,  or  even  water  gruel,  for  the  day,  rather 
than  give  any  doubtful  milk. 


DANGERS   FROM   IMPURE   MILK;    WHEN  STERILIZATION 
IS   NECESSARY 

Is  sterilization  of  milk  necessary  in  the  country  for  a  child  of 
fourteen  months?  What,  specifically,  are  the  microbes  to  be 
feared  from  non-sterilization?  I  mean,  are  they  germs  of 
known  diseases?  What  particular  harm  is  done  by  spoiled 
milk? 

It  can  be  told  only  by  the  results.  If  the  consumer  of  the 
milk  escapes  disease  it  was  not  necessary  to  sterilize.  But 
we  would  say  that  it  is  probable  that  if  you  control  your 
milk-supply— including  care  of  cow,  its  stabling,  care  of  the 
milk  and  all — you  are  safe.  The  amount  of  simple  filth 
which  is  separated  from  ordinary  milk  by  the  centrifugal 
separator  is  appalling.  The  germs  of  known  diseases  which 
may,  and  not  so  very  rarely  do,  infect  milk  are  those  of  tuber- 
culosis, scarlatina,  and  typhoid  fever.  Other  diseases  are 
less  frequently  conveyed  by  milk.  In  addition,  there  is  a 
good  deal  of  harm  done  by  the  bacteria  which  cause  the  ordi- 
nary spoiling  of  milk,  and  which  set  up  bowel  troubles ;  and 
—rarely,  it  is  true— the  terrible  poison  tyrotoxicon  causes  a 
vicious  choleraic  disorder. 


FEEDING  PROBLEMS  421 

KEEPING   STERILIZED   MILK   IN   SUMMER 

Will  you  tell  me  whether  you  think  it  necessary  to  keep  steril- 
ized milk  on  ice  during  the  warm  weather?  Our  summers 
are  quite  severe  at  times,  the  thermometer  registering  from 
80°  to  95°  in  the  house.  I  have  never  used  the  sterilized  milk 
before  in  the  warm  season,  and  so  I  am  ignorant  as  to  what  I 
should  do.  At  present  I  keep  the  bottles  in  as  cool  and  breezy 
a  window  as  I  can  find.  The  milk  is  thoroughly  sterilized, 
boiling  hard  forty-five  minutes,  and  has  never  yet  disagreed 
with  my  nine-months-old  baby,  who  has  taken  it  almost  since 
birth. 

Milk  which  is  thoroughly  sterilized  and  thoroughly  well 
corked  need  not  be  iced.  In  fact,  so  far  as  its  sterility  goes, 
it  ought  to  stand  anything  so  long  as  the  bottles  are  tight. 
AVhen  milk  is  only  partially  sterilized  or  imperfectly  corked, 
or  in  any  way  neglected  in  the  preparation,  of  course  this 
remark  will  not  hold.  In  every  case  of  doubt  the  bottles 
should  be  iced. 

DOES   STERILIZED   MILK   CONSTIPATE? 

Are  there  not  cases  where  sterilized  milk  will  produce  consti- 
pation ? 

Yes,  practically.  That  is  to  say,  the  milk,  having  been  ren- 
dered unirritating  by  sterilization,  no  longer  stimulates  the 
bowels  to  the  degree  that  raw  milk  does,  and  is  constipating 
in  the  same  sense  that  white  bread  is  constipating  as  com- 
pared with  coarse  bread.  To  speak  more  accurately,  we 
should  say  that  sterilized  milk  was  not  laxative  as  compared 
with  uncooked  milk ;  and  so  some  infants  using  the  sterilized 
become,  temporarily  at  least,  more  constipated  than  before. 

INJURIOUS   QUALITY   OF   LIME-WATER 

Will  you  kindly  give  me  the  proportion  of  lime-water  to  be  used 
in  a  seven-ounce  bottle  of  sterilized  milk?     Some  physicians 


422       THE  CENTURY  BOOK  FOR  MOTHERS 

say  a  tablespoonful,  others  say  that  amount  is  very  injurious 
for  a  child  nine  months  of  age,  and  that  a  teaspoonful  is  all 
that  should  be  used.  If  a  tablespoonful  is  given,  what  bad 
results  would  follow  its  use? 

The  amount  varies  v^^ith  conditions.  Thus,  if  a  child  were 
ill,  we  might  use  more  than  we  would  in  health.  Again,  it 
varies  with  the  milk.  The  object  of  the  lime-water  is  to 
change  the  reaction  of  the  milk  mixture  so  that  it  shall  re- 
semble that  of  breast  milk.  Thus,  breast  milk  is  usually 
slightly  alkaline.  Cowl's  milk,  as  milked,  is  neutral  or  slightly 
acid;  as  sold,  usually  distinctly  acid.  We  are  speaking  of 
chemical  reaction  as  shown  by  litmus  paper,  not  by  taste. 

In  making  a  food  mixture  w^e  usually  add  lime-water  after 
sterilization  until  the  mixture  is  slightly  alkaline.  A  seven- 
ounce  mixture  wdll  usually  be  made  alkaline  by  five  per  cent, 
of  lime-w^ater,  say  two  and  a  half  or  three  teaspoonf uls.  But 
if  the  ''sterilized  milk"  be  undiluted  milk,  then,  probably, 
more  lime-water  w^ould  be  needed.  We  do  not  think  that  a 
tablespoonful  w^ould  produce  any  distinctly  bad  results,  but 
if  a  less  amount  of  alkali  wall  produce  the  result  it  is  better 
in  health  to  use  less. 

Litmus  paper  is  cheap ;  it  can  be  bought  of  a  druggist,  who 
will  show  you  how^  to  use  it.  It  should  be  cut  into  very  slen- 
der slips  and  kept  in  a  tightly  corked  vial. 

FOOD   VERSUS    SLEEP 

My  baby,  four  weeks  old,  will  sleep  three,  four,  and  five  hours  at 
a  time.  Should  he  be  awakened  to  feed  him?  Ke  has  never 
had  any  kind  of  soothing  syrup. 

He  certainly  need  not  be  aw^akened  at  night.  By  day  the 
feeding  wdll  need  to  be  attended  to  rather  more  frequently, 
if  regular  habits  are  to  be  established.  The  child  need  not 
be  rudely  aw^akened,  but  when  the  time  for  his  food  arrives, 
the  bottle  can  be  prepared,  the  nipple  put  into  his  mouth, 
and  the  child  gently  aroused  sufficiently  to  take  the  food. 


FEEDING  PROBLEMS  423 


THE   PREPARATION   OF    BARLEY-WATER;   ADVISABILITY 

OF   STERILIZATION;    QUANTITY   OF   MILK   AND 

BARLEY-WATER   FOR   A    ONE-YEAR-OLD 

I  shall  not  wean  my  baby  of  ten  months  and  a  half  for  another 
month  or  two,  but  would  like  to  know  whether  you  would  ad- 
vise sterilized  milk  or  the  top-milk  plan.  If  the  latter,  will 
you  kindly  give  directions  how  to  prepare  the  same,  also  how 
to  prepare  barley-water  to  use  with  sterilized  milk?  I  must 
depend  upon  a  milkman  for  the  milk,  and  thought  on  that 
account  the  sterilized  would  be  better  than  the  top-milk.  I 
nurse  my  boy  every  three  hours  during  the  day.  He  weighs 
twenty-two  pounds  and  has  four  teeth. 

How  much  milk,  or  milk  and  barley-water,  should  he  take  in 
twenty-four  hours  ? 

For  a  child  of  a  year  it  is  not  necessary  to  prepare  milk  as 
for  a  young  infant.  Milk  diluted  with  barley-water  will  do 
well  enough.  The  milk  may  be  sterilized  if  there  is  any 
doubt  of  its  perfect  purity  and  sweetness,  or  if  there  is  doubt 
as  to  its  keeping.  Sterilization  is  not  an  attenuation  of  top- 
milk  or  any  other  mixture.  Any  mixture  may  be  sterilized 
if  desired.     It  is  a  method  of  preserving,  not  of  mixing. 

A  good  receipt  for  barley-water  is  this :  Three  tablespoon- 
fuls  of  pearl  barley,  three  cupfuls  of  boiling  water,  and  just 
enough  salt  to  take  off  the  "flat"  taste. 

Pick  over  and  wash  the  barley  carefully.  Cover  with  cold 
water  and  soak  four  hours.  Put  the  boiling  water  into  a 
farina  kettle,  stir  in  the  barley  without  draining,  and  cook, 
covered,  for  an  hour  and  a  half.  Strain  through  coarse  mus- 
lin, salt  and  sweeten  slightly,  and  give  when  it  is  cool  enough 
to  be  drunk  with  comfort.  He  will  take,  if  he  has  an  average 
appetite,  three  pints  of  milk  and  barley-water  at  a  year  old, 
and  will  probably  take  more  soon.  The  mixture  at  the  begin- 
ning may  be  half-and-half,  but  presently  gradually  increase 
the  proportion  of  milk. 


424  THE  CENTURY  BOOK  FOR  MOTHERS 

THE   VALUE   OF   BARLEY   AND   OATMEAL   GRUEL 

Is  not  barley  gruel  with  milk  more  constipating  than  milk  diluted 

with  water? 
Why  is  it  considered  better  to  use  barley  gruel  or  oatmeal  gruel 

with  the  cow's  milk  for  a  child  with  weak  digestion? 

Barley  gruel  does  not,  in  our  judgment,  increase  the  consti- 
pating effect,  but  it  is  less  laxative  than  oatmeal  gruel. 

The  salts  contained  in  the  gruels  are  useful,  and  many- 
believe  (while  some  disbelieve)  that  the  gruels  favor  the  for- 
mation of  a  finer  and  more  digestible  curd  of  milk  on  the 
stomach. 


HARMFULNESS   OF   NEW   BREAD   AND   COOKIES 

Will  you  please  say  a  convincing  word  to  mothers  against  the 
use  of  new  bread  and  cookies  for  the  little  ones?  I  know  many 
a  mother,  so  careful  lest  her  child  get  wet  or  "take  cold,"  who 
yet  destroys  digestion  by  the  use  of  these  two  articles  of  diet; 
and  by  no  means  is  it  the  uneducated  mother  alone  who  thinks, 
as  one  said  to  me,  that  "fresh  bread  is  good  enough  for  any 
one."  I  suppose  that  new  bread  and  pies,  more  than  climate 
or  work,  have  made  us  the  nation  of  dyspeptics  that  we  are. 

We  doubt  if  we  can  say  a  "convincing  word,"  for  we  believe 
the  habit  of  giving  children  such  things  comes  not  from 
ignorance,  but  from  that  lazy  amiability  which  prefers  to 
gratify  them  at  the  moment  rather  than  to  deny  them  any- 
thing at  the  cost  of  some  self-denial  and  perhaps  transient 
trouble.  AVe  can  hardly  imagine  that  intelligent  persons 
really  suppose  these  things  good  for  children,  but  they  sim- 
ply follow  their  natural  bent  and  deny  the  harmfulness  of 
any  course  they  like  to  pursue. 

THE   RELATIVE  MERITS  OF  GRAHAM  AND  WHITE  BREAD 

Please  inform  me  as  to  the  relative  merits  of  Graham  and  white 
bread  for  a  child  sixteen  months  old? 


FEEDING  PROBLEMS  425 

The  theoretical  Graham  flour  is  unbolted  and  contains  the 
bran.  Practically,  if  we  mistake  not,  this  is  not  entirely  true. 
Graham  bread,  as  sold  in  the  shops,  seems  to  be  made  of 
something  like  half  Graham  and  half  white  flour.  Assum- 
ing, however,  that  you  have  a  real  unbolted  wheat  flour— 
and  we  ought  first  to  premise  as  regards  all  we  here  say  that 
the  child  has  its  first  molars,  or  chewing  teeth— the  differ- 
ences would  be  about  as  follows :  The  wheat  bread  would  be 
a  trifle  the  more  digestible  if  both  were  equally  well  made 
and  equally  stale— i.  e.,  not  fresh.  The  Graham  would  be 
the  more  nutritious  if  digested.  The  Graham  would  also  be 
rather  more  laxative,  especially  if  it  be  made,  as  is  usual, 
with  the  addition  of  a  little  molasses.  Much  would  depend 
upon  individual  digestive  ability.  If  Graham  bread  were 
given  its  effect  should  be  noted. 

BALLS   FROM    GRAHAM   FLOUR 

Could  not  flour-balls  be  made  from  whole-wheat  flour,  or  rather 
from  sifted  Graham,  which  would  be  more  laxative  and  more 
nutritious  than  if  made  from  white  flour?  We  buy  the  whole 
wheat  and  have  it  ground  fine,  and  use  a  great  deal  of  it  in 
the  family. 

They  could  be  made  from  those  flours,  but,  as  the  composi- 
tion of  the  white  flour  is  changed  by  the  prolonged  boiling, 
similar  changes  will  take  place  in  the  Graham  flour,  and  if 
that  part  only  which  will  pass  through  a  sieve  is  to  be  used, 
the  result  would  probably  be  almost  identical  with  the  ordi- 
nary flour-ball.     There  is,  however,  no  harm  in  trying  it. 

GRAHAM,  OATMEAL,  AND   THE   VARIOUS 
PREPARED    CEREALS 

What  do  you  consider  the  most  wholesome  flour  of  which  to  make 
bread?  What  is  Graham  flour,  and  what  is  its  value  as  a  food, 
actual  and  as  compared  with  other  flours? 

What  do  you  think  of  oatmeal  as  an  article  of  food?     What  is 


426  THE  CENTURY  BOOK  FOR  MOTHERS 

the  most  nutritious  and  palatable  preparation  of  any  grain 
known  to  you  in  a  form  suitable  for  use,  say,  on  the  breakfast- 
table. 

All  things  considered,  we  should  regard  a  very  finely  ground 
wheat-meal  the  best  for  bread  for  ^'the  average  man."  Theo- 
retically, Graham  flour  is  such  a  meal;  practically,  we  are 
inclined  to  think  some  parts  are  removed.  As  made  at  bak- 
eries, Graham  bread  contains  bolted  flour  to  dilute  the  Gra- 
ham flour.  If  made  at  home  it  becomes  a  very  wholesome 
and,  to  many  persons,  palatable  bread.  White  flour  has  lost 
much  of  the  nutrient  part  of  the  grain  and  is  very  largely 
starch.  Some  persons— those  of  the  ^' gouty  diathesis,"  for 
instance— are  injuriously  affected  by  a  starchy  diet;  for  such, 
white  bread  is  not  very  wholesome. 

Oatmeal  is  very  nutritious  and,  if  well  cooked,  an  excellent 
article  of  food.  In  our  judgment,  however,  many  persons 
more  than  offset  its  nutritive  value  by  injurious  amounts  of 
syrup  or  sugar  eaten  upon  it.  With  salt  and  milk,  or  cream, 
it  is  to  most  stomachs  digestible  and,  to  our  taste,  delicious. 
Meal  of  poor  quality  or  badly  cooked  is  detestable.  Oatmeal 
and  the  various  forms  of  cracked  or  crushed  wheat— the  trade 
names  are  legion — which  retain  the  entire  grain,  are  the 
most  nutritious  of  grain  foods  for  the  breakfast-table.  The 
palatability  must  be  judged  by  the  eater.  Occasionally  oat- 
meal disagrees,  being  popularly  said  to  be  "heating,"  par- 
ticularly to  persons  with  a  tendency  to  eruptions. 


HONEY   AND   MOLASSES 

What  is  your  opinion  of  honey  and  the  ordinary  brands  of  mo- 
lasses as  a  part  of  the  dietary  of  children? 

Honey  is  a  mixture  of  several  sugars  and  of  other  things. 
For  some  reason  it  often  disagrees,  and  persons  of  good  di- 
gestive power  not  infrequently  suffer  violent  attacks  of  indi- 
gestion from  it.     If  it  agrees  it  may  be  used  under  the  same 


FEEDING   PROBLEMS  427 

restrictions  as  other  sweets.  Concerning  molasses  as  an  ar- 
ticle of  food,  our  opinion  is  the  same  as  concerning  sugar. 
It  has  the  advantage  that  it  may  be  added  to  food  as  a  laxa- 
tive when  one  is  necessary,  but  it  is  inferior  to  some  fruits, 
if  they  are  obtainable. 


POP-CORN 

Will  you  please  say  whether  pop-corn  is  good  or  healthful  for 
children  between  the  ages  of  three  and  eight? 

There  is  a  long  gap  in  digestive  ability  between  the  years 
three  and  eight.  Pop-corn  eaten  at  a  meal,  and  well  chewed, 
although  not  a  desirable  food,  may  be  borne  well  by  many 
children  of  eight.  We  should  not  think  of  giving  it  to  those 
of  three.  But  there  remains  the  objection  that  children  do 
not  eat  pop-corn  at  meals,  but  at  other  times  when  they 
should  not  eat  anything. 


OATMEAL   GRUEL  AS   A   LAXATIVE 

Please  send  directions  for  making  oatmeal  gruel  to  use  as  a 
laxative. 


Oatmeal  gruel  is  made  in  many  ways  to  suit  the  taste— i.  e., 
with  or  without  milk,  with  or  without  sugar,  etc.  It  should 
alw^ays  be  salted.  When  used  as  a  laxative  diluent  of  milk 
it  should  be  made  only  of  oatmeal,  boiling  water,  and  salt. 
Four  tablespoonfuls  of  the  meal  will  be  enough  for  a  quart 
of  water.  Add  salt,  say  half  a  teaspoonful,  to  the  oatmeal 
in  the  cooking- vessel ;  pour  on  the  quart  of  water.  The  pre- 
cise method  and  time  of  cooking  will  depend  upon  whether 
you  use  a  double  ''farina"  kettle  or  a  simple  saucepan.  In 
the  latter  case  it  must  be  stirred  to  prevent  burning,  and  the 
evaporated  water  made  good  from  time  to  time.  An  hour's 
boiling  is  usually  enough. 


428  THE  CENTURY  BOOK  FOR  MOTHERS 

IS   OATMEAL  "HEATING"? 

My  little  girl  of  four  is  very  fond  of  oatmeal,  and,  in  fact,  pre- 
fers it  to  anything  else.  During  last  summer  some  of  our 
friends  thought  we  gave  her  too  much  oatmeal,  considering  it 
too  heating.  Is  this  the  case  ?  And  if  so,  is  not  oatmeal,  then, 
of  corresponding  value  in  winter? 

It  is  one  of  the  stock  phrases  which  some  people  are  fond  of 
repeating,  that  oatmeal  is  ''too  heating."  If  this  phrase  has 
any  particular  meaning,  it  is  this,  that  some  persons,  par- 
ticularly in  summer,  do  not  easily  digest  oatmeal,  as  evi- 
denced by  flatulence,  by  constipation  in  some  cases,  or  by  a 
tendency  to  skin  eruptions.  If  these  or  any  other  symptoms 
which  your  physician  thinks  may  be  fairly  attributed  to  the 
oatmeal  occur,  it  would  be  proper  to  stop  or  diminish  the  oat- 
meal ration.  But  you  say  that  it  does  agree  with  your  child 's 
digestion,  and  mention  no  other  symptoms.  So  we  are  left 
to  conclude  that  your  friends  have  no  other  ground  for  their 
suggestion  than  the  desire  to  appear  wise  by  giving  irrespon- 
sible advice. 


INCOMPATIBILITY   OF    FRUIT   AND    MILK 

What  is  there  in  the  popular  idea  that  milk  and  fruit  do  not 
go  well  together?  My  little  ones  are  inclined  to  constipation, 
so  they  need  all  the  fruit  they  can  digest ;  but  they  must  either 
go  without  milk,  which  is  one  of  their  chief  articles  of  diet, 
or  eat  the  fruit  at  their  meals  with  their  milk,  or  eat  the  fruit 
between  meals,  which  seems  to  me  a  bad  habit  to  establish. 
Which  of  the  three  ways  is  best  ? 

The  incompatibility  varies  with  different  fruits  and  with 
different  digestions.  So  far  as  a  general  rule  can  be  given, 
it  is  this:  You  know  that  many  fruits— baked  apples,  peaches, 
berries— are  habitually  served  with  cream,  said  "cream" 
being  as  often  as  not  only  top-milk.  Very  acid  or  unripe 
fruits  do  seem  sometimes  to  disturb  the  digestion  of  milk. 


FEEDING  PROBLEMS  429 

Ripe,  sweet  fruits  generally  do  not  have  this  effect,  and  may 
be  given,  if  the  child  is  old  enough  to  have  fruit,  irrespective 
of  milk.  One  reason,  it  seems  to  us,  that  milk  and  fruit  dis- 
agree is  this:  They  are  eaten  together,  and  whole  berries, 
perhaps,  with  tough  skins,  or  unchewed  pieces  of  larger  fruit, 
are  washed  down  and  cannot  be  readily  attacked  by  the  di- 
gestive juices.  We  have  supposed  that  the  indigestion  some- 
times following  huckleberries  and  milk,  for  instance,  was 
due  to  this  fact,  and  would  not  have  occurred  if  the  berries 
had  been  served  dry  and  the  child  obliged  to  chew  them 
well,  the  milk  being  swallowed  later  in  the  meal.  In  giving 
fruit  to  children  the  parent  must  carefully  select  for  each 
child  what  it  is  to  eat,  and  see  that  it  is  properly  prepared. 
Cooked  fruit  and  milk  rarely  disagree— the  traditional  baked 
apple  and  milk,  for  instance. 

The  habit  of  giving  fruit  between  meals  is  not  bad  if  the 
fruit  hour  is  fixed  and  it  is  made  a  meal.  This  may  be  on 
rising— which,  when  constipation  exists,  is  a  very  good  time 
—or  it  may  be  between  breakfast  and  the  midday  meal.  To 
young  children  we  prefer  not  to  give  any  uncooked  food  ex- 
cept milk  after  the  latter  meal. 


STRAWBERRIES   AT   FOUR   YEARS 

I  would  like  to  know  what  you  think  of  strawberries  for  a  child 
of  four  years? 

There  is  no  fruit  about  which  there  is  so  much  uncertainty 
as  the  strawberry,  owing  to  the  quite  common  idiosyncrasy 
which  makes  its  possessor  unable  to  eat  the  strawberry  (as 
well  as  some  other  things)  without  severe  indigestion  or  an 
attack  of  hives  (urticaria).  Nevertheless,  if  experiment  re- 
veals no  such  peculiarity,  we  believe  strawberries  admissible 
at  the  age  you  mention,  provided  they  are  fully  ripe  and 
fresh,  that  they  are  taken  early  in  the  day  or  at  noon,  and  do 
not  form  a  part  of  the  same  meal  as  milk.  Good  berries,  ripe 
enough  to  eat,  need  but  little  if  any  sugar  (how  good  the  old 


430        THE  CENTURY  BOOK  FOR  MOTHERS 

hillside  berry  was  without  any!),  and  taken  with  a  biscuit 
or  a  slice  of  bread,  the  quantity  moderate,  make  a  proper 
part  of  the  midday  meal,  or  may  form  the  forenoon  luncheon 
usually  needed  by  the  four-year-old. 

SMUGGLING   MILK   INTO   THE   BILL   OF   FARE 

What  is  to  be  done  if  a  child  refuses  railk  altogether?  My  little 
girl  of  a  year  and  a  half  takes  the  milk  with  her  cereals  nicely, 
but  does  not  like  it  by  itself  or  in  the  shape  of  prepared  foods. 

If  I  cannot  teach  her  to  like  it,  what  would  you  advise? 

There  are  some  children  who  do  not  like  milk.  The  only 
way  is  to  coax  in  all  you  can.  A  little  later  on  it  can  be  hid- 
den in  various  dishes;  for  instance,  celery  soup  and  clam 
broth  can  be  made  to  introduce  a  good  deal  of  milk  into  the 
system.  If  these  do  not  succeed,  the  albuminoids  can  be 
made  up  by  the  use  of  broths,  finely  chopped  meats  once  a 
day,  eggs  occasionally.  The  fats  can  be  made  up  by  butter, 
cream,  egg  yolk,  fat  meat,  or,  in  an  emergency,  cod-liver  oil. 

BANANAS,  APPLES,  AND   ORANGES 

Can  a  healthy  boy  twenty-two  months  old  eat  half  a  banana  at  a 
time,  or  any  banana  at  all?  And  if  not,  why  not?  He  has 
been  given  a  quarter  of  an  apple  at  once  and  part  of  an  orange, 
and  sometimes  grapes,  with,  of  course,  skins  and  seeds  always 
removed.  These  three  last  fruits  he  has  had  for  a  number 
of  months  past. 

He  should  have  no  uncooked  banana  at  all.  Only  the  most 
accomplished  masticator  can  do  anything  with  the  tenacious 
pulp.  It  is  palatable,  but  even  for  adult  use  it  should  be 
either  very  thinly  sliced  or  scraped  up.  In  our  judgment,  it 
it  a  hazardous  experiment  to  give  this  fruit  to  any  child 
who  is  not  at  least  five  years  of  age.  The  apple  is  not 
advisable,  but  if  you  scrape  the  pulp  very  fine  it  may  be 
given   if   constipation   demands   it;    otherwise,    wait.      The 


FEEDING  PROBLEMS  431 

orange,  carefully  divested  of  seeds  and  of  the  fibrous  part 
(best  accomplished  by  cutting  the  orange  across  and  feeding 
with  a  spoon  what  you  wish  to  give  the  child),  will  prob- 
ably do  no  harm;  the  grapes,  perhaps,  are  also  admissible  if 
carefully  prepared,  but  in  hot  weather  they  would  better  be 
omitted.  A  child  of  the  age  mentioned  should  not  be  allowed 
to  feed  itself  with  fruit. 

THE    USES   OF   SAGE-TEA 
Is  sage-tea  beneficial  to  children? 

Sage-tea  is  sometimes  of  use  medicinally.  It  was  anciently 
held  in  high  esteem,  but  is  now  chiefly  used  in  domestic  medi- 
cine. It  makes  a  good  gargle,  especially  with  the  addition 
of  alum  and  honey.  It  is  also  useful  as  a  tonic  to  the  stomach 
when  there  is  flatulence,  and  sometimes  allays  nausea.  Made 
weak,  it  is  a  grateful  drink  to  many  persons  in  fever. 

THE   ABUSE   OF   SUGAR 

Should  sugar  be  a  constant  ingredient  in  the  simple  food  (bread 
and  milk,  rice  and  milk,  etc.)  given  to  a  child  under  two  years 
of  age?  One  hears  that  too  much  of  it  causes  digestive  dis- 
turbances.    Is  it  necessary  for  the  child  to  have  any? 

In  our  opinion,  after  a  child  is  old  enough  to  eat  rice  or 
bread,  sugar  is  not  needed  at  all.  If  it  can  properly  digest 
these  articles  of  food  it  can,  from  their  starchy  constituents, 
manufacture  enough  sugar  for  its  needs.  We  think  it  far 
better  to  teach  the  child  to  take  its  bread  and  milk  or  rice  and 
milk  with  a  proper  seasoning  of  salt,  and  without  any  sugar 
at  all.  To  add  sugar  is  only  to  tickle  the  palate  at  the  risk 
of  the  digestion  and  general  health. 

BREAKING   THE   "BOTTLE    HABIT" 

Can  you  tell  me  how  to  cure  a  child  of  the  "bottle  habit"?  Al- 
though nearly  four  years  of  age,  she  still  clings  to  her  bottle, 


432       THE  CENTURY  BOOK  FOR  MOTHERS 

and  if  we  wish  to  spend  the  day  or  evening  out,  that  bottle 
has  to  go  along.  Is  it  good  for  a  child  of  that  age  to  stick  to 
the  habit  so?  We  have  tried  all  manner  of  expedients  without 
avail. 

We  have  seen  such  eases  of  late  use  of  the  bottle.  The  habit 
is  of  no  use  to  the  child,  perhaps  not  a  positive  detriment 
to  her  digestion,  but  it  is  a  harm  to  her  morale  to  be  allowed 
to  dictate  to  her  parents  at  her  age.  We  have  known  in- 
stances of  the  parents  waiting  until  the  child  w^as  old  enough 
to  be  shamed  out  of  the  habit.  But  there  is  one  simple  w^ay, 
and  only  one,  of  breaking  the  habit— that  is  to  take  away  the 
bottle.  It  wdll  make  a  trouble  for  twelve  or  twenty-four 
hours,  but  if  the  parents  do  not  yield— simply  preparing  the 
food  and  offering  it  in  a  glass— at  the  end  of  that  time  it  will 
be  taken,  sparingly,  perhaps,  at  first,  but  presently  in  full 
quantities.  This  assumes,  of  course,  that  there  is  no  de- 
formity of  the  mouth,  and  that  the  child  can  drink  water. 
It  strengthens  the  resolve  of  yielding  parents  to  break  every 
bottle  in  the  house  before  beginning  the  experiment.  It  is 
better  not  to  begin  than  to  yield. 

TEACHING   BABY   TO   EAT;    THE   NEED   OF  WATER 
TO   QUENCH   THIRST 

My  six-months-old  baby  is  a  large  twenty-four-pound  boy  who 
has  never  been  sick  and  is  just  as  healthy  and  happy  as  a  baby 
can  be.  Two  teeth  are  now  through  without  any  trouble,  and 
this  leads  me  to  suppose  the  time  has  arrived  for  feeding  him, 
as  up  to  the  present  he  has  never  tasted  anything  but  milk  of 
nature's  own  providing.  There  seems  as  yet  to  be  no  lack  of 
this  natural  supply,  but  is  not  the  presence  of  the  teeth  an 
indication  that  he  ought  now  to  be  taught  to  eat?  If  so,  what 
food  ought  first  to  be  given  him,  how  often,  and  in  what 
quantities  ? 

Ought  little  babies  to  drink  cold  water? 

The  presence  of  teeth  is  not  an  indication  that  he  ought  now 
to  be  taught  to  eat.     Inferences  from  ''indications"  have 


FEEDING  PROBLEMS  433 

to  be  drawn  very  carefully,  or  else  we  shall  overlook  very 
evident  counter-indications.  If  the  child  were  taught  to 
take  artificial  food  his  two  teeth  (incisors)  would  be  of  little 
help  to  him;  he  cannot  bite  liquid  food  with  them,  and  he 
cannot  chew  solid  food  until  he  gets  his  molars.  This  child 's 
weight  and  prompt  dentition  are  evidence,  so  far  as  they  go, 
of  his  health  and  proper  nutrition.  The  question  for  you  to 
decide  is  how  much  longer  you  can  properly  nourish  him 
alone.  This  question  you  may  have  to  refer  to  your  family 
physician.  When  you  have  decided  this  you  can  begin  to 
teach  the  child  to  take  artificial  food  as  a  preparation  for 
complete  weaning. 

Cool  water  may  be  given  to  babies,  but  not  iced  water, 
as  a  rule.  They  often  are  thirsty  and  nurse  only  to  quench 
thirst  and  not  hunger.  The  quantity  of  water  given  at  one 
time  should  be  small. 


PURE  VERSUS   DILUTED  MILK   AT   TWO 
AND   A   HALF  YEARS 

Is  it  advisable  to  dilute  the  milk  for  a  child  of  two  and  a  half 
years?  It  is  claimed  by  my  wife  that  the  milk  is  too  rich,  and 
that  with  a  slight  admixture  of  water  it  agrees  better  with 
our  boy.  I  think  that  since  milk  is  his  principal  nourishment 
he  ought  to  have  it  pure,  and  that  if  rich  it  is  all  the  better  on 
that  account. 

The  child  enjoys  his  meals  and  seems  to  be  in  good  health,  as 
far  as  we  can  tell. 

The  answer  depends  upon  the  quality  of  the  milk  and  the 
digestive  powers  of  the  child.  A  child  of  two  and  a  half 
years,  of  ordinary  digestive  power,  can  take  the  milk— espe- 
cially if  warmed  slightly— of  an  ordinary  cow  undiluted. 
Jersey  milk,  with  an  unusual  amount  of  cream,  may  be  too 
heavy  if  pure.  But  it  is  always  safe  to  err  on  the  side  of 
over-dilution,  and  to  make  up  the  nourishment,  if  necessary, 
by  increased  quantity. 


434  THE  CENTURY  BOOK  FOR  MOTHERS 


BUTTERMILK   AS   FOOD   FOR  CHILDREN 

Do  you  consider  buttermilk  a  suitable  drink  for  a  child  of  four? 
My  daughter  is  exceedingly  fond  of  it  and  generally  prefers 
it  to  sweet  milk.  It  agrees  witli  her  perfectly.  If  given  at 
all,  is  it  just  as  good  in  the  morning  as  at  any  other  time  ? 

There  is,  in  our  experience,  buttermilk  and  buttermilk.  One, 
the  buttermilk  which  has  stood  a  good  while  before  skimming, 
and  which  is  bitter  and  sometimes  sour;  this  we  recom- 
mend to  no  one.  The  other  is  sweet  and  innocuous.  We 
know  of  no  good  reason  why  a  child  should  not  drink  it. 
It  is  no  more  difficult  of  digestion  than  ordinary  milk,  and 
to  some,  perhaps,  less  so.  Of  course,  the  absence  of  fat  re- 
moves from  it  the  laxative  element,  and  it  would  probably  be 
less  laxative  than  ordinary  whole  milk.  We  think  it  would  be 
just  as  good  in  the  morning  as  at  any  time. 


ICE-CREAM 

Do  you  consider  vanilla  ice-cream  injurious  to  children  above 
three  years  of  age,  if  given  in  small  quantities  and  eaten 
slowly? 

To  this  question  an  explicit  answer  cannot  be  given.  In  the 
first  place,  simple  ice-cream  (not  the  remarkable  concoctions 
of  the  confectioner,  but  a  simple  mixture  of  cream  and  sugar, 
with  flavor,  frozen),  in  moderate  quantity,  would  seem  to 
be  as  inoffensive  as  any  sweet  that  could  be  devised.  But 
whether  or  not  it  is  so  depends  upon  several  things.  First 
of  all,  the  same  cream  Avhich,  eaten  slowly  (small  pieces  being 
allowed  to  melt  in  the  mouth),  would  be  harmless,  would 
help  to  set  up  an  indigestion  if  large  pieces  were  allowed  to 
go  to  the  stomach  while  very  cold. 

But  in  our  judgment  a  great  distinction  is  to  be  made 
between  those  who  can  and  those  who  cannot  eat  sweets. 
We  know  that  there  is  a  very  large  class  of  people  who  can- 


FEEDING  PROBLEMS  435 

not  safely  eat  much  of  certain  things  (sweets,  starchy  food, 
including  bread,  potatoes,  and  many  others  seemingly  harm- 
less), without  sooner  or  later  suffering  for  it  in  some  way. 
This  group  of  persons  are  called  the  gouty.  They  are  rela- 
tively more  abundant  among  the  head-workers  than  the  hand- 
workers. The  offspring  of  such  persons  early  show  this  in- 
ability to  properly  dispose  of  sweets,  and  to  such  children 
even  ice-cream  is  not  harmless. 


INORDINATE   FONDNESS   FOR   SALT 

My  little  girl,  three  years  old,  apparently  healthy,  is  very  fond  of 
common  table  salt,  I  am  sometimes  obliged  to  punish  her  to 
keep  her  from  eating  it  in  great  quantities.     Is  it  injurious? 

A  good  deal  of  salt  may  be  eaten  without  harm  except  the 
exciting  of  thirst.  Just  what  quantity  is  harmful  in  any 
given  case  cannot  be  definitely  stated.  The  best  way  is  to 
give  the  child  a  liberal  allowance  and  not  allow^  her  to  take  it 
herself.  Keep  account  of  the  amount  and  watch  results,  and 
if  you  find  any  disagreeable  ones  that  you  think  probably  due 
to  the  use  of  the  salt  diminish  the  quantity.  The  exact 
amount  meant  by  "great  quantities,"  of  course,  we  do  not 
know,  but  the  taste  and  the  desires  of  different  adults  vary 
greatly,  and  there  is  no  reason  why  those  of  children  should 
not. 

WHY   FROZEN   CREAM   IS   UNSUITABLE   FOOD 

Will  you  state  whether  milk  and  cream  undergo  any  chemical 
change  by  being  frozen?  I  have  noticed  so  often  that  cream 
after  being  frozen  does  not  mix  when  put  into  coffee;  the  fatty 
part  seems  to  separate  and  float  on  top.  Does  the  cream  de- 
teriorate in  any  way  for  children's  use  by  having  been  frozen? 

Cream,  when  first  raised,  consists  of  particles  of  fat  held  in 
suspension  in  the  watery  part  of  the  milk.  When  this  condi- 
tion of  emulsion  is  disturbed  the  fat  separates  in  the  form  of 


436  THE  CENTURY  BOOK  FOR  MOTHERS 

butter.  The  object  of  churning  is  to  mechanically  cause  this 
change.  Much  shaking  has  a  similar  effect,  and  we  have  often 
noticed  it  after  freezing,  and  suppose  that  the  change  is  due 
to  the  freezing.  Cream  Avhich  has  become  buttery  is  unde- 
sirable for  making  infant  food ;  in  fact,  the  fattest  kinds  of 
cream,  even  if  fresh,  are  not  so  good  as  lighter  sorts.  The 
fat  cream,  if  used,  should  be  used  in  place  of  butter  on  bread 
and  other  things  for  children  old  enough  to  eat  them. 


USES   OF   FAT   IN    FOODS 

Would  any  serious  difficulty  arise  from  a  lack  of  fat  in  the  food, 

and  what  would  be  its  first  indication  ? 
Would  not  a  lack  of  fat  be  favorable  to  the  good  health  of  a 

baby  who  evidently  has  a  strong  tendency  to  an  excess  of  flesh? 
My  youngest  has  been  using  artificial  food  over  two  months,  and 

has  been  growing  large  and  fat.     Is  not  that  an  evidence  that 

it  is  agreeing  with  her? 

Lack  of  fat  would  be  a  disadvantage  just  as  deficiency  of 
any  of  the  principal  elements  of  food  would  be.  There  has 
been  some  doubt  raised  as  to  whether  deficiency  of  fat  is  as 
serious  a  drawback  as  other  deficiencies,  and,  perhaps,  with 
the  great  safeguards  we  have  against  loss  of  heat  in  warm 
houses  and  clothing,  the  doubt  may  be  w^ell  founded.  But 
it  is  better  usually  to  keep  the  food  as  near  the  theoretical 
standard  as  is  practicable.  There  are  other  uses  of  fat, 
as  a  laxative,  for  instance,  which  should  not  be  over- 
looked. Besides,  in  the  first  year  lack  of  fat  seems  to  induce 
rickets. 

Fatty  food  does  not  much  tend  to  the  production  of  fat  in 
the  consumer.  The  sugars  and  starches  are  much  more  fat- 
tening. 

So  far  as  it  goes,  increase  in  size  is  evidence  of  food 
agreeing.  Growth  in  stature  is  a  better  evidence  than  simple 
increase  of  fat,  which  last  is  consistent  with  poor  nutrition 
in  other  ways. 


FEEDING  PROBLEMS  437 


VARIETY   IN    FOOD 


When  you  speak  of  a  simple  diet  for  children,  do  you  mean  that 

there  should  be  little  variety? 
Do  you  think  it  best  that  a  boy  of  two  and  a  half  should  have 

oatmeal  gruel  every  morning  if  it  agrees  with  him,  or  would 

you  vary  his  diet? 

Simple  diet  generally  means  simple  in  character.  Thus,  a 
piece  of  beef  roasted  or  steak  broiled  vv^ould  be  "simple," 
while  the  same  beef  as  part  of  a  beef  stew  would  not  be. 
We  do  think,  however,  that  young  children  should  not  have 
much  variety  in  kinds  of  food,  w^hile  they  may  have  a  variety 
in  the  kind.  For  instance,  take  the  cereal  preparations: 
they  are  used  monotonously  as  to  course,  but  one  may  vary 
the  course  with  oatmeal,  hominy,  or  a  w^heat  preparation. 

Unless  you  see  some  sign  of  disagreement  with  his  digestion, 
or  he  tires  of  it,  we  know  of  no  reason  why  he  may  not  have 
the  gruel  regularly. 


THE   EFFECT   OF   TEA  ON   CHILDREN 

I  want  to  ask  whether  you  think  that  a  teaspoonful  or  two  tea- 
spoonfuls  of  tea,  as  it  would  appear  in  an  ordinary  grown-up 
person's  cup,  put  into  the  hot  water  and  milk  of  children  of 
four  and  six  would  interfere  at  all  with  their  health?  The 
children  do  not  care  to  take  this  drink  of  hot  water  and  milk 
alone,  and  if  they  get  the  slightest  coloring  of  tea  or  coffee 
they  seem  to  relish  it — more,  I  think,  from  the  idea  that  they 
are  getting  something  that  others  are  having  than  from  any- 
thing else. 

It  is  not  probable  that  the  amount  of  tea  would  have  much 
effect.  W^e  cannot  definitely  say,  as  the  tea,  ''as  it  appears  in 
an  ordinary  grown-up  person's  cup,"  is  a  mixture  of  most 
variable  strength.  One  person  may  take  it  five  or  six  times 
as  strong  as  his  neighbor.  Further,  the  effects  of  different 
kinds  of  tea  vary  very  much,  and,  moreover,  the  suscepti- 


438  THE  CENTURY  BOOK  FOR  MOTHERS 

bility  of  different  persons  is  very  different,  and  to  some  the 
injurious  effects  seem  to  be  cumulative.  Let  us  assume,  for 
the  sake  of  argument,  that  the  tea  as  mixed  is,  as  such,  harm- 
less. What  is  accomplished?  You  have  made  the  children 
acquainted  with  a  stimulant  which  they  would  better  not 
know  before  adult  life,  and  you  have  let  them  understand 
that  by  persistence  they  may  have  at  table  something  which 
one  parent  at  least  thinks  is  not  good  for  them. 


COCOA 

Is  cocoa  a  good  breakfast  drink  for  young  children? 

By  cocoa  we  understand  an  unadulterated  preparation  of 
the  roasted  nut  of  good  quality.  There  are  all  sorts  of  prep- 
arations on  the  market,  varying  from  the  costly  chocolate 
down  to  the  husks  or  shells,  not  to  mention  adulterated  or 
spurious  articles.  For  a  young  child  the  addition  to  milk  of 
a  substance  rich  in  fat  and  nitrogenous  ingredients— as  is 
really  good  cocoa— makes  a  mixture,  in  our  judgment,  usually 
too  rich,  unless  it  be  understood  to  be  a  food  and  not  a  drink. 
Chocolate  and  bread  would  make  a  meal,  if  the  power  of 
digesting  fat  is  good.  The  multitude  of  preparations  of 
cocoa  from  which  the  fat  has  been  more  or  less  removed  we 
do  not  discuss,  as  it  would  require  a  minute  knowledge  of 
each  preparation. 

FEEDING   A   PREMATURE   CHILD 

My  child  was  a  little  seven-months  baby,  weighing  only  four 
pounds  at  birth,  and  now  at  five  months  he  weighs  ten  pounds. 
Has  he  gained  as  much  as  he  ought  to  have  done  under  the 
circumstances  ? 

Since  the  third  month  he  has  been  artificially  fed,  taking  ten 
tablespoonfuls  or  more  at  a  time  of  his  food  every  two  hours 
in  the  daytime  and  two  or  three  times  at  night.  Is  he  fed  too 
much  and  too  often? 


FEEDING  PROBLEMS  439 

Should  he  be  considered  and  treated,  as  regards  his  food,  as  a 
five-months  or  a  three-months-old  baby? 

The  gain  seems  very  satisfactory,  his  weight  being  two  and 
a  half  times  what  it  was  at  birth. 

Probably  you  could  begin  to  widen  the  intervals  of  feeding 
with  advantage. 

It  is  not  easy  to  say  for  how  long  and  how  much  allow- 
ance should  be  made  for  premature  birth.  We  think  it  safe 
to  make  an  allowance,  gradually  diminishing,  until  the  end 
of  a  year,  and  longer  if  the  child  is  feeble.  Your  baby  at  five 
months,  for  instance,  could  be  considered  a  four-months  baby ; 
at  ten  months,  as  nine  and  a  half.  This,  of  course,  is  only 
approximate,  and  the  real  guide  is  the  condition  as  to 
strength,  etc.,  of  the  particular  baby. 


BUTTER   AND   EGGS   FOR  A   CHILD   OF 
DELICATE   DIGESTION 

I  have  a  little  girl  of  two  and  a  half  years,  and  should  very 
much  like  to  have  your  views  regarding  butter  and  eggs  as  a 
regular  diet  for  her.  She  has  had  added  to  her  hominy  and 
milk  a  little  cream,  also  a  little  cream  to  her  milk  for  break- 
fast. After  the  hominy  she  has  had  a  soft-boiled  egg,  topping 
off  with  bread  and  butter.  She  has  just  had  a  bilious  attack, 
vomiting  at  intervals  for  some  hours.  She  threw  off  consid- 
erable bile.  Finally,  after  a  sufficient  lapse  of  time,  a  mix- 
ture of  bismuth  was  given  to  her,  when  she  went  to  bed  and 
slept  soundly  throughout  the  night,  and  was  "as  bright  as  a 
button"  in  the  morning,  and  is  all  right  now.  What  I  wish 
to  avoid  is  a  repetition  of  the  attack.  What,  then,  is  your 
opinion  of  butter,  in  the  first  place,  if  given  liberally  to  chil- 
dren, and  what  do  you  think  of  a  soft-boiled  egg  every  morn- 
ing as  part  of  baby's  breakfast?  My  little  one  has  a  delicate 
frame  and  digestion,  but  is  perfectly  well  and  healthy. 

Butter  in  moderation  is  usually  advantageous  as  being  an 
easily  assimilated  animal  fat.     But  it  would  seem  that  you 


440  THE  CENTURY  BOOK  FOR  MOTHERS 

have  given  it  to  your  little  girl  without  moderation.  Thus, 
she  had  it  in  the  milk  on  her  hominy;  she  had  more  in  the 
added  cream,  again  in  the  milk  she  drank  and  in  the  second 
added  cream,  and  then  she  "topped  off"  with  more  on  her 
bread.  Probably,  altogether,  she  got  at  least  as  much  as  a 
man  of  strong  digestion  would  take  for  his  breakfast.  It 
does  not  seem  necessary  to  add  cream  to  good  undiluted  milk 
— indeed,  usually  it  is  injudicious,  and  a  child  who  uses  much 
good  milk  does  not  need  additional  butter. 

The  fresh  egg  also  is  usually  well  borne,  and  probably  will 
be  again  if  you  moderate  the  amount  of  fat  you  give  with 
it.  Try  hominy,  milk,  and  the  egg,  giving  the  egg  on  alter- 
nate days,  limiting  the  amount  of  milk  at  that  meal  and 
watching  the  effect. 

The  fact  that  your  little  one  has  a  delicate  digestion  should 
render  you  careful,  and  she  may  be  one  of  those  persons  (who 
are  not  so  common  as  is  supposed)  with  whom  eggs  do  not 
agree ;  but  before  believing  this,  try  the  above  suggestions. 


PROPER   DILUTION   OF   CONDENSED   MILK 

Nature  has  deprived  me  of  nourishment  for  my  little  one,  who 
is  five  months  old.  I  have  given  her  condensed  milk,  properly 
diluted  with  water  that  has  been  boiled,  with  a  tiny  pinch  of 
salt  and  a  little  lime-water  added  to  it.  These  are  the  pro- 
portions: six  ounces  boiled  water,  two  teaspoonfuls  of  con- 
densed milk,  a  pinch  of  salt,  two  teaspoonfuls  of  lime-water. 
She  takes  about  this  amount  every  three  hours  during  the  day 
and  about  half  the  amount  once  during  the  night.  She 
weighed  seven  pounds  at  birth,  and  now,  at  five  months,  weighs 
seventeen  pounds,  and  seems  very  strong.  Her  only  difficulty 
is  constipation,  which  I  have  heard  is  a  usual  occurrence  with 
bottle-fed  babies. 

Would  you  continue  with  the  condensed  milk,  when  she  has 
gained  so  much,  and  seems  so  well,  and  I  have  used  nothing 
else?     If  not,  what  do  you  recommend  that  is  better? 

Am  I  using  the  right  proportions  for  her  age,  and  are  forty-two 
ounces  too  much  in  quantity  for  twenty-four  hours? 


FEEDING  PROBLEMS  441 

When  a  child  is  really  doing  well  we  do  not  advise  change 
even  if  the  food  is  not  what  it  ought  to  be.  Many  children, 
like  many  adults,  have  sufficient  digestive  power  to  be  nour- 
ished by  imperfect  food.  In  practice— especially  in  dispen- 
sary practice— condensed  milk  is  often  the  best  food  that  can 
be  obtained,  and  its  deficiency  in  fat  can  be  made  up  by 
using  cod-liver  oil,  and  the  sugar  deficiency,  which  exists  if 
it  is  properly  diluted,  made  up  by  adding  sugar. 

This  being  the  case,  it  is  not  easy  to  say  what  are  correct 
proportions  as  regards  a  food  which  is  admittedly  imperfect. 
Condensed  milk  which  is  preserved  and  canned  is  inferior 
to  that  made  by  the  same  makers  and  sold  in  many  cities 
from  delivery  wagons.  This  last  is  only  a  substitute  for 
good,  ordinary  milk  whenever  the  latter  is  not  to  be  easily 
had.  AVe  think  that  you  dilute  the  condensed  milk  too  much 
for  an  adequate  food;  its  high  dilution  makes  it  easily  di- 
gested but  not  very  nutritious.  By  increasing  the  strength 
of  the  mixture  somewhat,  from  time  to  time,  you  can  increase 
its  nutritive  power  while  you  watch  the  digestion.  If  you 
wish  to  try  another  kind  of  food  altogether,  we  would  sug- 
gest that  it  be  done  under  the  advice  of  a  good  physician 
who  has  looked  the  baby  over  carefully  to  see  what  is  lacking 
in  her  nutrition. 


A  "HARD-REARED"   BABY 

My  baby  has  attained  the  age  of  sixteen  months.  He  has  been 
unavoidably  bottle-fed,  and  has  been  what  many  would  call  a 
"hard-reared  baby,"  but  now  seems  perfectly  healthy  and 
fairly  developed,  walking,  but  not  talking,  and  boasting  the 
possession  of  ten  teeth.  His  diet  is  still  confined,  of  course, 
to  milk,  cream,  oatmeal,  an  occasional  fresh  egg,  roast  potato, 
and  bread  and  butter,  of  which  last  he  is  inordinately  fond. 

So  far  so  good.  But  baby  has  one  or  two  bad  habits  that  seem 
to  grow  with  his  growth — first,  exceeding  restlessness  at  night ; 
second,  there  seems  to  be  an  impossibility  of  weaning  him  of 
night  feeding,  or  drinking  rather. 

He  has  never,  I  believe,  slept  a  night  continuously,  whatever  his 


442  THE  CENTUEY  BOOK  FOR  MOTHERS 

state  of  health.  Just  now  his  program  is  to  wake  once,  say 
about  2  A.M.,  scream  violently  for  a  few  minutes,  and  insist 
on  having  some  one  take  him  from  his  crib  to  amuse  and 
pacify  him,  and  finally,  after  about  half  an  hour's  recreation, 
he  condescends  to  accept  a  full  bottle  and  retires  with  his 
treasure.  Frequently  he  drinks  two  or  three  bottles  of  milk 
through  the  night,  although  in  the  day  he  never  looks  for  one, 
drinking  from  a  glass  or  cup  at  meal-times. 
I  am  quite  at  my  wits'  end.  What  am  I  to  do?  If  I  let  him 
cry  on  without  heed  or  help,  it  seems  to  me  he  will  certainly 
cry  himself  to  sickness,  so  violently  does  he  set  about  it;  and 
how  can  I  wean  him  from  drinking? 

We  will  give  what  help  we  can  on  the  facts  stated.  The 
phrase  '^ hard-reared"  we  interpret  to  mean  that  his  rearing 
Avas  difficult,  either  from  distinct  sicknesses  or  from  some 
delicacy  or  feebleness;  if  the  latter,  most  probably  digestive 
derangements.  He  no\v,  at  sixteen  months,  has  ten  teeth, 
probably  the  eight  incisors  and  two  of  the  first  molars. 

His  ''tv^^o  bad  habits"  may  be  considered  as  manifesta- 
tions of  one.  To  give  the  cause  of  them,  of  course  one  should 
know  a  great  many  things  not  stated  in  the  query.  But  one 
cause  is  suggested  by  the  facts  given.  A  child  wdth  prob- 
ably only  tw^o  molars  has  among  its  articles  of  diet  two  things 
notably  hard  of  digestion  at  his  age,  and  digestible  only 
after  prolonged  chewdng— namely,  potato  and  bread.  Both 
of  them  contain  starch  in  a  very  large  proportion.  Fine 
Avheat  flour  contains,  according  to  some  analyses,  upw^ard  of 
seventy  per  cent,  of  starch,  and  bread  made  from  it  nearly 
fifty  per  cent.,  some  of  the  starch  having  been  changed  by  the 
raising  and  cooking  of  the  bread.  Ra^v  potato  has,  say,  nine- 
ty-two per  cent,  of  starch.  Now%  without  claiming,  as  some 
seem  inclined  to  do,  that  starch  is  the  great  poison  of  infancy, 
it  cannot  be  denied  that  it  is  very  indigestible  to  children. 
Only  prolonged  chewing  makes  its  digestion  probable  in 
adult  life,  and  to  many  people  it  is  always  indigestible.  To 
an  infant  as  yet  unsupplied  wath  chewang-teeth  (molars)  it 
must  be  very  difficult  of  digestion.     The  form  of  indigestion 


FEEDING  PROBLEMS  443 

need  not  be  one  that  must  cause  immediate  pain,  or  perhaps 
any  great  pain  at  all,  but  it  may  lead  to  derangements  of  a 
remoter  kind.  This  may  not  be  the  ease  with  your  child,  but 
we  cannot  help  associating  the  starch  and  the  restlessness. 

The  demand  for  the  ''full  bottle"  is  probably  a  natural 
sequence  of  the  other  troubles,  or  it  may  be  partly  habit— 
we  cannot  speak  with  precision  for  want  of  information.  We 
presume  you  have  tried  water  to  make  sure  it  is  not  thirst 
that  troubles  the  child.  If  you  have  not,  try  if  a  bottle  of 
water,  not  too  cold,  will  not  content  him.  Many  children, 
however,  demand  the  bottle  because  they  have  been  taught 
all  their  short  lives  to  expect  something  to  be  put  into  their 
mouths  as  the  preliminary  to  sleep.  They  do  not  need  food 
any  more  than  many  men  need  spirits,  but  they  have  gained 
a  habit.  If  we  had  to  deal  with  a  wakeful  or  restless  child, 
and  could  find  out  only  the  things  you  have  stated,  we  should 
first  get  rid  of  the  starch,  giving  in  place  of  the  milk  diet  for 
one  meal  some  beef -juice  or  good  plain  broth  (bouillon)  of 
beef  or  mutton.  If  he  craved  bread  he  should  have  only  the 
hard  crust,  which  is  more  digestible  than  the  soft  crumb  and 
portions  of  which  cannot  be  swallowed  until  they  have  been 
diligently  chewed  off  from  the  piece.  The  details  of  the  re- 
maining management  would  depend  upon  the  success  attend- 
ing the  change  of  diet.  It  is  well,  however,  in  the  case  of  any 
"hard-reared"  child,  to  have  occasional  advice  from  the 
physician,  who  can  work  out  all  the  real  facts.  What  has 
been  said  above  is  based  on  the  few  placed  before  us. 

PROBABLE  OVERFEEDING;    FREQUENT  CHANGES  OF 
FOOD;   EXCESSIVE  VOMITING 

Ever  since  my  baby  was  born  he  has  vomited  a  great  deal.  I 
gave  up  nursing  him  when  he  was  three  months  old  and  have 
tried  everything  for  him,  but  the  vomiting  still  continues,  to 
an  almost  unlimited  extent.  The  child  grows  steadily,  never- 
theless. Would  you  advise  me  to  keep  on  trying  the  different 
foods  until  I  get  something  which  seems  to  agree  with  him, 
or  go  back  to  the  sterilized  milk  with  water  and  a  little  sugar 


444  THE  CENTURY  BOOK  FOR  MOTHERS 

and  lime-water,  and  just  endure  the  vomiting  ?  It  occurs  from 
the  time  he  has  taken  his  bottle  possibly  until  three  hours 
after.     Is  it  healthful  or  not? 

Vomiting  is  not  healthful.  Regurgitation  of  food,  if  the 
amount  has  been  excessive,  is  not  a  sign  of  disease  but  of  a 
physiological  protest  on  the  part  of  the  stomach  against  such 
treatment.  Just  how  long  you  have  been  trying  to  get  a 
food  to  suit  does  not  appear,  as  the  age  of  the  child  at  the 
time  of  writing  is  not  given,  and  it  may  be  that  the  child's 
digestion  could  be  put  right  promptly  by  a  little  medical 
advice.  But  on  general  principles  we  may  say  that  we  do 
not  approve  of  changing  from  food  to  food.  The  changes  are 
not  usually  made  for  any  reason  except  that  the  present  one 
is  not  satisfactory.  No  attempt  is  made  to  ascertain  why 
it  disagrees,  nor  if  the  next  would  probably  be  better.  If  we 
had  to  try  we  should  expect  better  success  from  a  good  milk 
mixture,  varying  the  dilutions  as  indications  arose,  than 
from  any  series  of  artificial  foods. 

SUGGESTIONS   FOR   IMPROVING   THE   DIETARY 
IN   A  CASE  OF  SLOW  TEETHING 

My  baby  is  fifteen  months  old,  has  only  seven  teeth,  and  weighs 
twenty-seven  pounds.  I  feed  her  on  broth  and  milk  only, 
diluted  with  oatmeal  gruel.  The  doctor  says  her  slow  teething 
is  due  to  insufficient  nourishment,  and  advises  me  to  put  soda 
crackers  in  her  milk,  and  give  her  grits,  biscuits,  and  meat  to 
eat.  Do  you  think  she  should  have  them  ?  Are  crackers  better 
than  light  bread? 

You  put  us  in  the  dilemma  of  choosing  between  our  own 
opinion,  formed  on  general  principles,  about  a  case  which 
we  have  not  seen,  and  the  opinion  of  a  physician  on  the  spot 
who  has  seen  the  case.  It  is  usually  safer  to  take  the  opin- 
ion of  the  man  near  by.  Nevertheless,  there  is  no  harm  in 
telling  you  the  general  principles  which  would  guide  us. 
First  of  all,  the  weight,  twenty-seven  pounds,  is  good  enough 
for  a  child  of  fifteen  months.     The  teething  is  slow.     One 


FEEDING  PROBLEMS  445 

would  expect  all  the  incisors  and  the  first  molars  in  a  breast- 
fed child  of  fifteen  months ;  a  bottle-fed  child  might  be  less 
forward.  The  weight  and  the  state  of  teething  are  all  the 
facts  concerning  the  child  you  give  us.  Perhaps  the  physi- 
cian based  his  judgment  on  many  other  things  which  you 
have  not  told  us  or  have  not  noticed.  However,  proceeding 
on  these  two  facts  as  a  basis,  we  should  say  that  backward 
teething  alone  is  not  sufficient  ground  for  us  to  make  a  diag- 
nosis of  rickets,  that  form  of  malnutrition  which  particu- 
larly retards  the  development  of  the  teeth.  But  assuming 
that  we  did  consider  that  such  a  child,  whose  weight  was  be- 
yond the  average,  was  really  insufficiently  nourished,  what 
would  be  the  food  we  should  add  ?  Would  it  be  starchy  food, 
like  bread  or  crackers,  cereals,  or  potatoes?  Now,  for  the 
proper  digestion  of  starchy  articles,  they  must  be  well  chewed 
and  mixed  with  saliva.  A  child  without  chewing-teeth  can- 
not chew  well,  but  if  he  had  abundant  saliva  we  might  let 
him  try  some  of  the  starchy  articles.  But  they  must  be  given 
in  such  a  way  that  the  saliva  shall  be  mixed  with  them.  This 
is  not  accomplished  by  mixing  them  with  milk  to  be  quickly 
swallowed,  but  by  giving  them  as  dry  as  possible,  so  that  they 
must  be  sucked  and  chewed  a  great  deal  before  swallowing. 
For  instance,  giving  a  crust  of  bread  from  which  the  soft 
part  has  been  scraped  away,  or  a  slice  of  stale  bread  browned 
slowly  in  the  oven,  buttered  when  cold  if  butter  be  desired,  is 
a  favorite  method  with  us  for  accomplishing  this  purpose. 
The  kinds  of  soda  crackers  with  which  we  are  familiar  are 
generally  crumbly  and  not  very  well  adapted  to  the  purpose. 
If  browned,  as  before  described,  slowly  in  the  oven  to  a 
golden-brown  tint,  they  ^dll  do  better.  There  are  many 
things  that  may  be  given,  but  we  have  confined  ourselves  to 
the  questions  propounded. 


LOSS  OF  APPETITE;   IMPERFECT  NUTRITION 

My  baby  girl  is  nearly  eleven  months  old;  she  weighs  twenty- 
two  pounds  and  was  doing  nicely  until  lately,  when  she  seems 
to  have  lost  all  her  appetite,  taking  hardly  a  bottleful  through 


446  THE  CENTURY  BOOK  FOR  MOTHERS 

the  day.  I  feed  her  on  milk  and  some  artificial  food.  What 
had  I  best  do?  She  has  but  two  teeth,  yet  she  is  said  by  all 
to  be  a  healthy-looking  child.  Her  hands,  however,  have  been 
often  cold  and  clammy. 

The  little  girl  has  one  evidence  of  good  health— namely,  fair 
weight.  On  the  other  hand,  if  a  child  of  eleven  months  has 
but  two  teeth  there  is  reason  to  think  that  in  some  way  its 
nutrition  is  defective.  In  this  case,  moreover,  the  hands 
have  been  cold  and  clammy,  which  may  be  taken  as  an  evi- 
dence of  an  imperfect  circulation.  At  the  moment  of  our 
correspondent's  writing  the  appetite  had  failed.  There  are 
many  points  which  are  not  stated,  but  we  may  give  her  a 
few  hints  regarding  things  to  be  looked  after  in  her  baby's 
case.  The  slow  coming  of  teeth — in  this  instance  not  so  very 
slow— is  usually  suggestive  of  that  form  of  malnutrition 
called  rickets. 

The  loss  of  appetite  in  a  small  child  will  ordinarily  be 
better  overcome  by  the  removal  of  the  cause  than  by  the  ad- 
ministration of  tonics.  The  mother  should,  therefore,  look 
to  the  condition  of  the  digestive  apparatus  as  well  as  she  is 
able.  She  should  notice  if  baby 's  tongue  is  clean  or  furred ; 
whether  the  movements  are  natural  as  to  color,  consistency, 
and  smell,  or  whether  they  are  too  dark  or  too  light  colored 
and  chalky,  constipated,  or  too  liquid,  offensive  in  smell,  or 
too  sour.  Even  if  she  is  unable  to  correct  the  abnormal  con- 
dition, it  will  enable  her  to  give  to  the  physician,  when  called, 
so  clear  an  account  of  the  state  of  affairs  that  he  can  pre- 
scribe with  much  greater  certainty  and  effect.  The  mother 
may,  however,  do  something  by  herself.  If  there  be  con- 
stipation with  the  furred  tongue,  the  familiar  remedy  of  the 
spiced  syrup  of  rhubarb  with  the  bicarbonate  of  soda  in 
proper  dose  will  be  pretty  certain  to  afford  relief,  at  least  for 
the  time.  If  the  movements  are  white  and  chalky,  no  rem- 
edy that  can  be  prudently  used  without  medical  advice  will 
be  found  more  beneficial  than  the  phosphate  of  soda ;  a  small 
pinch  of  the  powdered  phosphate  may  be  dissolved  in  a  bottle 


FEEDING  PROBLEMS  447 

of  milk,  once,  twice,  or  thrice  a  day;  it  is  not  objected  to, 
as  it  resembles  common  salt  in  taste.  If  the  stools  are  sour, 
the  use  of  an  alkali— lime-water  if  they  are  loose,  bicarbon- 
ate of  soda  if  they  are  constipated— may  be  of  assistance. 
Better  than  all  dosing,  however,  for  correcting  a  disordered 
digestion  usually  is  the  change  of  food— bottle-fed  children 
are  here  alone  considered— and  our  preference  is  to  give  good 
sweet  milk,  diluted  with  water  or  barley-water,  in  place  of 
any  prepared  or  starchy  food.  By  means  of  this  change  and 
the  use  of  the  simple  remedies  mentioned,  much  can  be  done 
to  improve  the  condition  of  a  baby's  digestion;  still,  it  seems 
to  us  the  part  of  wisdom  not  to  carry  domestic  practice  very 
far  if  good  medical  advice  can  be  obtained,  but  rather  to 
procure  explicit  directions  suited  to  the  particular  case,  and 
exactly  to  follow  them. 

DISTASTE   FOR  MEAT 

My  little  girl  of  five  has  from  the  time  she  first  began  to  eat 
solid  food  had  a  dislike  for  meat  in  any  shape.  Neither  steak, 
nor  chops,  nor  fowl  will  tempt  her.  She  is  correspondingly 
fond  of  cereals,  vegetables,  and  fruit,  and  eats  a  fair  amount 
of  bread  and  butter,  eggs,  etc.  She  has  always  liked  milk. 
She  is  what  is  generally  called  a  nervous  child  and  not  par- 
ticularly robust,  although  in  fair  health  most  of  the  time. 
Do  you  think  that  she  ought  to  be  forced  to  eat  meat?  I 
don't  like  to  make  her  uncomfortable  at  meal-times,  and  there- 
fore have  not  tried  to  persuade  her  to  eat  it;  but  if  it  is  best 
for  her  health  to  do  so,  I  shall,  of  course,  do  everything  to 
overcome  her  dislike. 

There  are  few  more  disagreeable  minor  nuisances  in  society 
than  people  who  are  over-fastidious  in  the  matter  of  diet, 
and  education  ought  from  the  start  tend  to  make  children 
eat  all  wholesome  food.  Still,  it  is  not  advisable  to  force  a 
child  to  eat  what  it  honestly  loathes.  The  opposite  mistake 
is  to  humor  its  whims  until  one  can  hardly  find  enough  to 
keep  it  from  starvation  at  a  table  bountifully  supplied  with 


448       THE  CENTURY  BOOK  FOR  MOTHERS 

proper  dishes.  As  a  nation  we  depend  too  mneh  upon  flesh- 
pots  ;  yet  a  single  meal  daily  at  which  meat  is  served  is  almost 
a  necessity  if  one  would  have  sturdy  growth  of  health  and 
strength,  unless,  indeed,  a  liberal  supply  of  milk  and  eggs 
be  deemed  a  sufficient  substitute  for  meat.  Coax  and  tempt 
your  little  girl  to  overcome  her  idiosyncrasy.  Distaste  for 
meat  is  not  uncommon,  although  hardly  so  frequent  as  is  the 
disposition  to  eat  meat  heartily  to  the  exclusion  of  vegetables 
and  cereals.  Begin  with  insisting  that  a  small  piece  of  juicy 
meat  shall  be  slowly  masticated  and  swallowed  before  a  cov- 
eted dainty  is  given. 


INDEX 


INDEX 


Abdomen,   appearance  of,   in  illness, 

142 
Abdominal  fat,  excess  of,  392 
Absorbent  cotton,  for  sterilized  bottles, 

98  ;  for  surgical  needs,  184,  301 
Accidents,  what  to  do  in  case  of,  169- 

181 
Acetic  acid  for  removal  of  warts,  222 
Aconite,  tincture  of,  164 ;  poisoning,  181 
Adenoid  growths,  138 ;  meaning  of,  198*; 

cause  of  catarrhs,  238 
Adhesive  plaster,  use  of,  173 
Ailments  and  troubles,  minor,  193-218  ; 
bed-wetting,  206 ;   bed-wetting  in  a 
nervous  child,  207 ;  cause  and  cure  of 
hiccough,  208;  cause  of  pin-worms, 
213;  causes  and  treatment  of  colic, 
193 ;  causes  of  sore  mouth,  203 ;  coated 
tongue,   201;   cold  feet  as  a  conse- 
quence of  short  clothes,  197;   colic 
accompanying  nursing,  195;  colic  and 
teething,  194 ;  cracked  lips  and  chafed 
skin,  218;  cure  for  cold  hands,  196; 
drowsiness  following  a  bump  on  the 
head,   217;    excessive    nosebleeding, 
210;    enlarged  uvula,   199;   enlarge- 
ment of  glands,  198;   fainting,  218; 
gritting  the  teeth  as  a  symptom  of 
worms,  211 ;  patches  on  the  tongue, 
199;   persistent  itching  of  the  nose, 
214;  perspiring  feet,  197;  prevalence 
of  "sore mouth,"  202;  probable  cause 
of  mouth-breathing,  198;  roughness 
of  the  voice,   206;   signs  of  worms, 
212;  swollen  tonsils,  203;   treatment 
of  iDumps,   216;    treatment    of    pin- 
worms,  213;  three-months'  colic,  196; 
what  to  do  for  an  attack  of  false 
croup,  215 
Air,  fresh,  in  relation  to  colds,  233 
Albuminoids,  of  breast-milk,  78 
Alcohol,  uses  of,  171,  172,  185 
Alcoholic  beverages,  cautions  concern- 
ing, 391 ;  in  fever,  294 ;  supposed  ad- 
vantages of,  for  the  nursing  mother, 
37 
Alkaline  washes,  uses  of,  270,  271 
Alkalis,  as  emetics,  180;   for  indiges- 
tion, 261 
Aloes  tincture,  for  nail-biting,  305 
Alum,  powdered,  as  an  emetic,  187;  for 
nosebleed,  210 


Ammonia,  antidote  for,  180;    for  the 

nursery  pharmacy,  186;  various  uses 

of,  171,  172,  178 
Anal  obstruction  in  the  new-born,  25 
Animal  foods,  11 1-115 
Anise,  spirit  of,  187,  194 
Ankle,   sprain  of,  173 ;    weakness  of, 

247,  252 
Anodynes,   experimenting   with,   317; 

warning  against,  395 
Antidotes,  various,  in  accidental  poi- 
soning, 179,  189 
Antimony,  antidote  for,  180 
Antipyrine  poisoning,  181 
Antiseptics,  for  internal  use,  275 ;    in 

colds,  236 ;  in  domestic  surgery,  188 
Antitoxin,  experiences  with,  279,  280 
Appetite,  loss  of,  445 
Apples,  baked,  120;    as  laxative,  254; 

when  permissible,  107,  430 
Aromatic  spirits  of  ammonia,  for  the 

heartburn  of  pregnancy,  7 
Arrowroot  gruel,  99 
Arsenic,  antidote  for,  180 
Artificial  feeding,  expediency  of,  35  ;  in 

its  effect  on  weight,  60  ;  proprietary 

foods,  80 
Asafetida,  tincture  of,  for  colic,  194; 

for  nervousness,  386 
Asparagus,  116,  254 
Ass's  milk,  412 
Astigmatism,  345 
Atomizer,  use  of,  in  colds,  241 

Baby,  care  of  new,  25-29 ;  deformities 
to  be  inquired  into,  25  ;  exercise,  40- 
43;  first  bath,  13,  26;  special  pre- 
cautions, 27 ;  the  navel-string,  28 

Baby-basket,  13;  —  carriage,  40,  57;  — 
jumper,  398;  —  powder,  368 

Backwardness,  in  school  children,  76 

Bacteria,  in  milk,  85 

Banana,  value  of,  121 ,  430 

Band,  danger  from  tight,  396  ;  knitted, 
376 

Bandages,  how  to  make,  184 

Barefoot,  advisability  of  going,  383 

Barley-water,  as  a  diluent,  97 ;  prepa- 
ration of,  100,  423;  to  prevent  curd- 
ling of  milk,  261 

Bath,  as  a  remedial  agency,  151-155; 
cold,  for  nervousness,   370;   during 


451 


452 


INDEX 


pregnancy,  5;  effects  of  cold  and 
warm,  324;  how  to  give,  in  illness, 
153 ;  medicated,  152 ;  outing  after, 
326 ;  preparation  for  baby's,  15 ; 
sponges,  15;  temperature  of,  38 

Bathing,  at  night,  324 ;  baby's  bath- 
tub, 13;  in  the  surf,  39;  routine  of, 
38;  soap,  325 

Bed- wetting,  causes  of,  206;  in  a  ner- 
vous child,  207 

Beef,  in  the  child's  diet,  112 

Beef-juice,  100 

Beef -tea,  100 

Beet,  118 

Belladonna,  for  bed-wetting,  207 ;  oint- 
ment for  drying  up  the  mother's 
milk,  391 

Berries,  value  of,  121 

Bicarbonate  of  soda,  as  a  laxative,  255 ; 
as  disinfectant,  185;  for  burns,  173, 
186 ;  for  colic,  187 ;  for  weak  diges- 
tion, 261 

Bichlorid  of  mercury,  12 

Bicuspids,  appearance  of,  69 

'^BiUousness,"  262,  297 

Binder  or  band,  cautions  as  to,  300 ; 
use  of,  46 

Biscuit,  105 

Bismuth,  as  affecting  the  stools,  142 

Bites,  of  dogs,  etc.,  171 ;  of  insects,  171 

Biting  of  the  nails,  304 

''Black-heads,"  272 

Bladder,  irritation  of,  as  cause  of  bed- 
wetting,  207 

Blemishes,  various,  219-232 

Blood,  in  the  bowel  discharges,  132,  142 

Bones,  as  affected  by  infantile  scurvy, 
127 ;  changes  in,  due  to  rickets,  125 

Borax,  for  sprue,  200;  uses  of,  171 

Boric  acid,  as  disinfectant,  12 ;  as  nip- 
ple-wash, 36 ;  in  cleansing  eyes,  28 ; 
in  domestic  surgery,  185 

Bottle-feeding,  constipation  in,  255 ; 
general  rules,  80-99 

"  Bottle  habit,"  431 

Bottles,  cleansing  of,  94 ;  graduated,  94 

Bowel,  falling  of  the,  301 

Bowels,  disturbances  of  the,  124,  132; 
movement  of,  during  nursing,  195 

Bow-legs,  227,  228,  247 

Braces,  for  bow-legs,  228 

Brain,  concussion  of,  142;  water  on, 
298 

Brandy,  for  diarrhoea,  134 

Bread,  composition  of,  104;  Graham, 
254,  424;  harmfulness  of  new,  424; 
value  of,  in  the  nursery,  118 

Bread-crumb,  with  meat  or  eggs,  105; 
puddings,  120 

Breakfast-meal,  108 

Breast  milk,  amount  at  a  nursing,  314 ; 
as  affected  by  nervousness,  386;  can 
the  nurse's  or  mother's  milk  be  poi- 
sonous ?  411 ;  constituents  of,  77 ;  evi- 
dences of  suf&cient  supply,  34;  flow 


after  delivery,  411;  method  of  dry- 
ing up  the  mother's  milk,  391;  objec- 
tions to  giving  mother's  milk  with 
spoon,  413 ;  signs  of  insufficient,  415 ; 
supply,  as  compared  with  allowance 
of  bottle-fed  babies,  416 ;  testing  the 
quality,  412 

Breasts,  care  of,  during  pregnancy,  7; 
sensitiveness  of,  387,  388 

Breath,  holding  of,  303 

Breathing,  as  altered  by  illness,  140 

Bromides,  uses  of,  188 

Bronchitis,  beginning  of,  235;  cough 
of,  141;  mistaken  for  pneumonia  or 
pleurisy,  236 

Broths,  100 

Bruises,  treatment  of,  172 

Bumps,  drowsiness  following,  217; 
treatment  of,  172,  216 

Burns,  treatment  of,  173 

Butter,  for  a  child  of  delicate  diges- 
tion, 439;  of  breast  milk,  78,  79 

Buttermilk,  434 

Cake,  admissibility  of,  120 

Calomel,  159 

Camphor,  ice,  218;  tincture  of,  in  hot 
applications,  156;  to  allay  irritation, 
171 

Candy,  objections  to,  123;  supposi- 
tories, 256 

Cane-sugar,  as  substitute  for  milk- 
sugar,  79 

Canine  teeth,  67 

Canned  vegetables,  value  of,  118 

Canton  flannel,  for  garments,  51 

Capsicum,  for  coUc,  194 

Carbohydrates,  in  breast  milk,  79 

Carbolic  acid,  antidote  for,  180 ;  as  an- 
tiseptic, 12 ;  for  burns,  173 

Carminatives,  for  colic,  135,  187,  194 

Carriage  for  baby,  outfit  of,  40,  57 

Carron  oil,  173 

Carrot,  as  an  anti-scorbutic,  127 ;  value 
of,  118 

Casein,  of  breast  milk,  78;  of  cow's 
milk,  87 

Castor-oil,  how  to  give,  165;  uses  of, 
133,  159 

Catarrh,  causes  and  treatment  of,  238 ; 
communicability  of,  239;  meaning 
of,  235 ;  of  the  intestines,  212 ;  of  the 
stomach,  259;  of  throat  or  wind- 
pipe, 242;  preceding  whooping-cough, 
243 

Catechu,  tincture  of,  263 

Cathartics,  for  household  use,  186;  in 
bowel  disorders,  159 ;  uses  of,  133 

Catheter,  for  enemas,  183 ;  in  colic,  194 

Catnip  tea,  for  colic,  135,  196 

Cauliflower,  117 

Cautery,  for  removal  of  growth  at  the 
navel,  226 

Celery,  117,  254 

Cement  or  bony  layer  of  the  teeth,  66 


INDEX 


453 


Cereals,  admissibility  of,  in  the  child's 
diet,  99 ;  merits  of  various,  425 

Chafing,  due  to  napkins,  48 

Chalk,  as  an  emetic,  180;  mixture,  263 

Chapped  skin,  218 

Chest,  changes  in,  due  to  rickets,  125 

Chewing-gum  habit,  305 

Chewing-teeth,  104 

Chicken-broth,  value  of,  101 

Chicken-pox,  eruption  of,  147;  incuba- 
tion period  of,  145;  period  of  inva- 
sion, 146 

Chilblains,  174 

Chloral,  in  convulsions,  178;  poison- 
ing, 181 

Chloroform,  in  convulsions,  178 

Cholera  infantum,  133 

Chop,  when  admissible,  105 

Chorea,  293,  374 

Circumcision,  need  of,  74 

Cleft  palate,  230 

Clothing,  44-58,  244 

Club-foot,  73 

Cocoa  as  beverage,  122,  438 

Cod-liver  oil,  against  worms,  213;  how 
to  give,  165 ;  in  scrofula,  294 

Cold-cream,  use  of,  218 

Colds,  233-242 ;  causes  and  cure  of  ca- 
tarrh, 238;  comprehensive  questions 
regarding,  235;  fresh  air  in  relation 
to,  233;  head-cold,  241;  starving  a 
cold,  241;  taking  cold  easily,  240; 
treatment  of,  237;  various  kinds  of, 
233 

Colic,  accompanying  nursing,  195; 
causes  and  treatment,  193;  cry  in, 
35;  intestinal,  135;  relation  to  teeth- 
ing, 194;  supposed  to  be  due  to 
nervousness  in  the  mother,  385; 
"  three-months',  "196 

Collodion,  in  domestic  surgery,  184 

Color-blindness,  73 

Comedo,  or  "black-heads,"  273 

"Comforter,"  objections  to,  302 

Compresses,  cold,  155 

Concussion  of  the  brain,  vomiting  in, 
142 

Condensed  milk,  80,  440 

Confinement,  preparations  for,  9-17 

Constipation,  253-257;  Castile  soap  and 
candy  suppositories,  256;  during 
pregnancy,  4 ;  due  to  sterilized  milk, 
421;  enemata  and  laxative  medi- 
cines, 132;  effect  of  an  enema,  257; 
habitual,  127;  hygienic  treatment, 
129;  in  a  bottle-baby,  255;  in  both 
mother  and  child.  253 ;  in  the  mother, 
128;  magnesia  as  a  laxative,  254; 
massage,  130;  of  rickets,  124;  sup- 
positories, 131;  value  of  fat  as  a 
remedy,  128 ;  value  of  regular  habits, 
256 

Consumption,  unjustified  fear  of,  402 

Contagious  disorders,  caused  by  im- 
pure   milk,    84;    chicken-pox,    145; 


diphtheria,  139, 229 ;  German  measles, 
145;  measles,  144,  145,  146,  147; 
mumps,  145,  146,  148;  scarlatina,  84, 
144, 145, 146,  147,  229;  small-pox,  145; 
susceptibility  to  second  attacks,  307; 
symptoms  of,  144;  whooping-cough, 
141,  145,  243,  245 

Convulsions,  treatment  of,  178 

Copperas,  364 

Corns,  incipient,  355 

Corrosive  sublimate,  antidote  for,  180 

Coryza,  235 

Coughs,  "tight"'  and  "loose,"  235; 
varieties  of,  140;  whooping-cough, 
243 

Cow,  proper  care  of,  83 

Cow's  milk,  constituents  of,  86;  modi- 
fled,  88 ;  percentage  of  fat  in  various 
breeds,  86;  purity  of,  82;  separation 
of  cream,  95;  various  mixtures,  95; 
varying  proportions,  91 

Crackers,  105 

Cream,  as  a  laxative.  111,  254;  food 
formula,  264;  frozen,  unsuitabiLity 
of,  435;  separation  of,  95;  value  of, 
88 

Creatin,  101 

Creatinin,  101 

Creosote,  antidote  for,  180 

Cross-eyes,  339,  340 

Croup,  cough  of  spasmodic,  140;  cry 
in,  35, 139 ;  diphtheritic,  140 ;  hoarse- 
ness in,  236;  membranous,  280;  true 
and  false,  282 ;  what  to  do  in  an  at- 
tack of,  215 

Crown,  of  the  teeth,  67 

Crying,  as  a  cause  of  rupture,  395 ;  as 
evidence  of  hunger,  35;  caused  by 
over-feeding,  35 ;  due  to  thirst,  35 ; 
indicative  of  pain,  35;  in  illness, 
139 ;  sedatives  for,  394 

Curds,  of  breast  milk  and  cow's  milk, 
87 

Curvature,  of  the  legs,  73;  of  the 
spine,  73 

Custards,  120 

Cuts,  treatment  of,  169 

Dairies,  model,  83 

Dandruff,  351 

Dates,  value  of,  122 

Deaf-mutism,  231 

Deafness,  partial,  347 

Defects  and  blemishes,  219-232;  cleft 
palate  and  harelip,  230 ;  deaf -mutism, 
231;  fear  of  bow-legs,  227;  freckles, 
219 ;  habit  of  stumbling,  228 ;  lisping, 
224 ;  mark  on  baby's  face,  220 ;  reme- 
dies for  bow-legs,  228;  removal  of 
birth-mark,  221;  round  shoulders, 
226;  stammering,  222;  tongue-tie, 
229;  umbilical  growth,  225;  want  of 
symmetry  in  the  formation  of  head, 
225  ;  warts,  221 ;  whopper-jaw,  230 

Demulcents,  236 


454 


INDEX 


Desserts,  119 

Dentine,  or  ivory,  66 

Dentistry  for  young  children,  336,  337 

Dentition,  66-71 

Development  and  growth,  59-76;  of 
special  senses,  65 ;  phases  of,  307-312 

Diarrhoea,  of  rickets,  124;  of  typhoid 
fever,  288;  rules  for  all  cases,  133; 
summer  complaint,  262 ;  varieties  of, 
132 

Diet,  definition  of  nutritious,  242 :  dur- 
ing pregnancy,  3;  general  directions, 
77-123;  laxative,  253;  problems  con- 
cerning, 408-448;  the  mother's,  dur- 
ing nursing,  37,  390 

Digestive  disorders,  258-265  ;  apparent 
over-feeding,  263;  causes  and  cure  of 
scurvy,  127;  causes  of  dirt-eating, 
265;  changes  caused  by  rickets, 
125;  cure  of  rickets,  125;  disturbed 
sleep  due  to,  322 ;  domestic  treatment 
of  summer  complaint,  262;  due  to 
improper  feeding,  124-135;  enemata 
and  laxative  medicines,  132 ;  habitual 
constipation,  127;  habitually  coated 
tongue,  259;  hygienic  treatment  of 
constipation,  129;  indigestion,  264; 
infantile  scurvy,  126;  "liver  trou- 
bles," 261;  massage,  130;  paregoric 
for  green  movements,  265 ;  probable 
case  of  dyspepsia,  258 ;  remedies  for 
weak  digestion,  260;  rules  for  all 
cases  of  diarrhoea,  133;  signs  of 
rickets,  260 ;  stomach  indigestion  and 
coUc,  134;  suppositories,  131;  symp- 
toms of  rickets,  124;  varieties  of 
diarrhoea,  132 

Dinner-meals,  108 

Diphtheria,  experiences  with  antitoxin 
in,  279,  280;  how  long  do  germs 
linger?  365;  membranous  croup,  280; 
precautions  in,  277;  sequels  of,  229; 
symptoms  of,  139 

Diphtheritic,  croup,  140;  throat  trou- 
bles, 139.  281,  293 

Dipper,  for  removing  cream,  97 

Dirt-eating,  265 

Diseases,  277-301 ;  alcoholic  stimulants 
in  fever,  294;  antitoxin  as  a  pre- 
ventive and  cure,  280;  cod-liver  oil 
in  scrofula,  294;  croup,  282;  diph- 
theria and  membranous  croup,  280; 
falling  of  the  bowel,  301;  general 
experiences  with  antitoxin,  279 ;  Ger- 
man measles.  290 ;  heart-trouble,  293 ; 
hernia,  299,  300;  hydrocephalus,  298; 
malarial  disorders,  283,  284 ;  measles, 
289;  meningitis,  297;  mumps,  292; 
precautions  in  a  case  of  diphtheria, 
277 ;  protruding  navel,  300 ;  rheuma- 
tism, 291;  St.  Vitus's  dance,  293; 
scarlet  fever,  288;  sore  throat,  292; 
tape- worm,  295;  typhoid  fever,  286, 
287 

Disinfectants,   after  confinement,   12; 


for  domestic  surgery,  188;  sulphur 
fumigations,  363 ;  various  kinds,  364 

Disinfection,  of  paper  money,  368 

Dover's  powder,  for  colds,  237 

Dress  and  clothing,  44-58 ;  advisability 
of  going  barefoot,  383;  binder  or 
band,  46;  clothing  for  winter,  379; 
fashion  in  dress,  55;  for  pregnant 
women,  4;  garments  for  older  chil- 
dren, 57;  garters  and  stocking-sup- 
porters, 381;  Gertrude  suit,  50;  get- 
ting rid  of  pinning-blanket,  376; 
knitted  band,  376 ;  napkins,  46 ;  night- 
cap, 378  ;  night  coverings,  377 ;  night 
dress,  53 ;  old-fashioned  clothing,  50 ; 
principal  requirements,  45;  proper 
stockings  and  shoes  for  a  depressed 
toe,  382 ;  seasonable  dress  for  a  flve- 
months'-old,  376;  shoes,  54;  silk  or 
flannel?  376;  socks,  49;  stiff  soles 
for  babies,  381;  stocking-supporters 
and  drawers,  56 ;  stockings  at  night, 
378;  summer  dress,  378;  summer 
night-clothing,  378;  value  of  long 
stockings.  380 

Drooling,  332 

Drooping  shoulders,  311 

Drowning  accidents,  what  to  do  in, 
177 

Dullness,  in  school  children,  75 

Dysentery,  132 

Dyspepsia,  probable  case  of,  258 

Earache,  cause  and  prevention,  349; 
cry  of,  140 ;  significance  of  a  running 
ear,  350;  treatment,  346 

Ears,  evidences  of  trouble,  140;  hard- 
ening of  ear-wax,  349;  of  the  new- 
born, cleansing  of,  28;  partial  deaf- 
ness, 347;  prominent,  347;  removal 
of  foreign  bodies,  176 ;  tampering 
with  large,  348 

Eczema,  267,  353 

Effervescing  waters,  value  of,  in  preg- 
nancy, 16 

Egg  albumen,  79 

Eggs,  for  weak  digestion,  439;  value 
of.  Ill ;  when  admissible,  105 

Electricity,  for  the  removal  of  mother's 
marks,  221 

Emergencies,  169-181;  accidents  due 
to  poison,  179;  bruises  and  bumps, 
170;  burns  and  scalds,  173;  cautions 
as  to  fire,  174 ;  convxdsions,  178 ;  do- 
mestic surgery,  169;  drowning  acci- 
dents, 177;  frost-bite  and  chilblains, 
174;  nose-bleed,  176;  punctured 
wounds,  170;  ragged  wounds,  170; 
removal  of  foreign  bodies,  175; 
sprains,  173 

Emetics,  for  household  use,  187;  in 
poisoning  cases,  179 

Emulsions  of  cod-liver  oil,  how  to  give, 
165 

Enamel  of  the  tooth,  67,  333 


INDEX 


455 


Enema,  during  pregnancy,  7 ;  for  colic, 
135,  194;  for  constipation,  132,  255, 
257 ;  how  to  give  an,  160,  404 ;  in  con- 
vtilsions,  179 

Epilepsy,  nocturnal,  33 

Epsom  salts,  as  antidote  for  carbolic 
acid,  180:  as  purgative,  180;  doses 
of,  189 

Eruptions,  266-276;  black-heads,  272; 
characteristics  of  mild  and  of  serious, 
266;  "driving  in"  eczema,  267;  heat- 
rash,  268;  herpes,  272;  hives,  274; 
psoriasis,  270;  red-gum,  269;  ring- 
worm, 271;  seborrhoea,  271 

Exercise,  for  girls,  367;  for  older  chil- 
dren, 41 ;  rapid  carriage-driving,  398 

Expectorants,  237 

Extractives,  value  of,  101 

"Eye  teeth,"  67 

Eyes,  as  affected  by  illness,  137 ;  astig- 
matism, 345;  chronic  conjunctivitis, 
290 ;  clipping  the  eyelashes,  343 ;  eye- 
strain as  a  cause  of  headache,  343; 
granular  eyelids,  344;  needless  anx- 
iety about  brilliant,  341 ;  of  the  new- 
born, care  in  cleansing  the,  28;  pink- 
eye, 344;  pupils  of  different  sizes, 
341 ;  removal  of  foreign  bodies,  175 ; 
squint,  339 ;  sties,  342 ;  test  for  cross- 
eyes,  340;  "weeping"  eye,  343;  when 
babies  begin  to  see,  308 

Fainting,  what  to  do  in,  218 

Farina,  119 

Fats,  in  breast  milk,  78 ;  in  cow's  milk, 
86 ;  uses  of,  436 ;  value  of,  in  consti- 
pation, 128 

Fauces,  examination  of,  138 

Feeding,  77-123, 408-448;  abuse  of  sugar, 
431 ;  artificial,  80 ;  balls  from  Graham 
flour,  425;  bananas,  apples  and  or- 
anges, 430 ;  barley  water,  423,  424 ;  bot- 
tle versus  spoon,  413;  breaking  the 
"bottle  habit,"  431;  butter  and  eggs, 
439;  buttermilk,  434;  can  the  nurse's 
or  mother's  milk  be  poisonous  ?  411 ; 
cocoa,  438;  combined  nursing  and 
bottle-feeding,  414;  condensed  milk, 
440 ;  dangers  from  impure  milk,  420 ; 
diet  of  a  premature  child,  438;  die- 
tary in  slow  teething,  444;  distaste 
for  meat,  447;  does  sterilized  milk 
constipate]  421;  during  night,  92; 
effect  of  tea  on  children,  437;  effect 
of  the  mother's  diet  upon  the  child's 
teething,  417;  evils  of  early  mixed 
feeding,  417;  excessive  vomiting, 
443 ;  flow  of  milk  the  first  days  after 
deliverj^,  411;  fondness  for  salt,  435; 
food  versus  sleep,  422;  frequent 
changes  of  food,  443 ;  fruit  and  milk, 
428 ;  goat's  milk  and  ass's  milk,  412 ; 
Graham  and  white  bread,  424 ;  "hard- 
reared"  children,  441;  honey  and 
molasses,  426;  ice-cream,  434;  imper- 


fect nutrition,  445;  injurious  quan- 
tity of  lime-water,  421;  is  oatmeal 
heating  I  428 ;  keeping  sterilized  milk 
in  summer,  421;  loss  of  appetite, 
445 ;  need  of  water  to  quench  thirst, 
432;  new  bread  and  cookies,  424; 
night  feeding  after  weaning,  418; 
nursing  another  baby  in  addition  to 
one's  own,  416;  oatmeal  gruel,  424; 
oatmeal  gruel  as  a  laxative,  427 ;  ob- 
jections to  giving  breast  milk  with  a 
spoon,  413;  on  breast  milk,  77-79; 
over-feeding,  443 ;  popcorn,  427 ;  prob- 
lems concerning  diet,  408-448;  pure 
versus  diluted  milk,  433;  sage-tea, 
431 ;  scum  on  boiled  milk,  419;  selec- 
tion of  a  wet;-nurse,  408 ;  signs  of  in- 
sufiicient  breast  milk,  415;  straw- 
berries, 429;  "sucking  wind,"  414; 
supply  of  breast  milk  as  compared 
with  the  allowance  of  bottle-fed  ba- 
bies, 416 ;  teaching  baby  to  eat,  432 ; 
testing  the  quality  of  breast  milk, 
412;  tests  of  rich  milk,  419;  uses  of 
fat  in  foods,  436;  variety  in  food, 
437;  various  cereals,  425;  various 
milk  mixtures,  95;  warning  against 
sour  milk,  419;  when  sterilization 
is  necessary,  420 ;  why  frozen  cream 
is  unsuitable,  435 

Feet,  cold,  197 ;  disinclination  to  stand, 
249;  distorted,  356;  incipient  corns, 
355 ;  ingrowing  nails,  357 ;  perspiring, 
197 ;  turning  in,  249 

Fever,  indications  of,  143 ;  intermittent, 
284 ;  malarial,  284,  367 ;  remedies  for, 
188;  typhoid,  288;  use  of  thermom- 
eter in,  143,  183 ;  varieties  of,  144 

Figs,  value  of,  122 

Filters,  proper  and  improper,  362 

Finger-nails,  care  of,  400 

Fingers,  supernumerary,  25 

Fir-pillow,  319 

Fire,  accidents  due  to,  174 

Fish  as  food,  113 

Flannel  garments,  56,  377 

Flatulence,  as  cause  of  colic,  135 

Flaxseed,  poultices,  156;  tea,  236 

Follicular  tonsilitis,  139,  293 

Fomentations,  155 

Fontanelles.  closing  of,  64 

Food  and  feeding,  77-123,  408-448 ;  ani- 
mal foods,  111 ;  artificial  feeding,  80- 
99;  bottles,  nipples  and  measures,  93", 
breast  milk,  constituents  of,  77 ;  bread 
and  cereals,  118;  broths  and  meat- 
juice,  100 ;  cereal  foods,  80 ;  chewing 
teeth,  104;  constituents  of  cow's  milk, 
86;  cow's  milk,  81;  desserts,  119; 
feeding  after  the  second  year,  108; 
feeding  conveniences,  97;  feeding  of 
older  children,  103 ;  fish  as  food,  113 ; 
five  meals,  108 ;  fruit,  121 ;  fruits  as 
laxatives,  107 ;  general  rules  for  diet, 
109 ;  gruels,  99 ;  gruels  and  porridges, 


456 


INDEX 


106;  macaroni,  119;  malted  foods,  80; 
meat  and  eggs,  104;  milk  foods,  80; 
modified  milk,  88;  objections  to 
sweets,  122;  potatoes,  107;  pm-ity  of 
the  milk  supply,  82 ;  second  year,  101 ; 
separation  of  cream,  95 ;  soups.  115 ; 
sterilization,  98 ;  third  year  and  there- 
after, 111 ;  value  of  eggs.  111 ;  value 
of  variety,  437;  various  meats,  112; 
various  mixtures,  95;  various  prob- 
lems concerning  diet,  408-448 ;  vary- 
ing proportions  in  feeding,  91 ;  vege- 
tables, 115;  water  and  other  drinks, 
122 ;  zwieback  and  crackers,  105. 

Foot,  natural  shape  of  baby's,  54 

Foot-warmer,  57 

Foreign  bodies,  in  eye,  ear,  nose,  etc., 
175 

Foreskin,  irritation  of,  321 

Fountain  svringe,  uses  of,  183 

Freckles,  219 

Front  teeth,  development  of,  67 

Frost-bite,  174 

Fruits,  as  laxatives,  107 ;  incompatibil- 
ity with  milk,  428 ;  various  kinds,  121 

Fuller's  earth,  270 

Fungous  growth  at  the  navel,  226 

Furniture  of  the  nursery,  23 

Gargling,  value  of,  in  sore  throat,  292 

Garments,  problems  concerning,  376- 
384;  various,  44-58 

Garters,  381 

Gauze,  for  household  surgery,  184,  301 

German  measles,  eruption  of,  146;  in- 
cubation period  of,  145 ;  isolation  pe- 
riod, 147;  peculiarities,  290;  period 
of  invasion,  145 

Gertrude  suit,  the,  50 

Girls,  growth  of,  as  compared  with 
boys,  61,  63 

Glands,  enlarged,  198 

Glauber's  salt,  as  antidote  for  carbolic 
acid,  180 

Glycerin,  enema,  135;  for  sprue,  201; 
suppositories,  131,  255 

Goat's  milk,  412 

Graduated  glass  for  medicines,  182 

Graham  bread,  254,  425 ;  flour,  425 

Granular  eyelids,  344 

Grape  juice,  value  of,  in  infantile 
scurvy.  127 

Grapes,  121 

Grippe,  cough  of,  141 ;  poison  of,  236 

Gritting  of  the  teeth,  211 

"  Growing  pains,"  292 

Growth  and  development,  59-76 ;  back- 
wardness, 76;  gain  in  height,  62; 
gain  in  weight,  59;  muscular  devel- 
opment, 64 ;  need  of  proper  hygienic 
surroundings,  74;  outgrowing  de- 
fects, 73;  overstudy  and  precocity, 
75;  phases  of,  307-312;  phimosis,  74; 
satisfactory  evidences  of,  71 ;  special 
senses,  65 


Gruels,  admissibilty  of,  99 ;  how  to  pre- 
pare, 106 

Gum  lancet,  need  of,  71 

Gums,  affected  by  infantile  scurvy, 
126;  tenderness  of,  138,  329 

Gymnastic  exercises  for  stammering, 
223 

Habits,  chewing  of  gum,  305;  harm- 
ful, 302-306;  holding  the  breath,  303; 
lip-sucking,  306;  nail-biting,  304; 
objections  to  "baby's  comforter," 
302;  thumb-sucking,  302 

Hair,  belief  that  long  hair  is  weaken- 
ing, 353;  falling  out  after  confine- 
ment, 393;  strengthening  of  thin, 
351;  tampering  with  the  color  of, 
353 

Hammock,  as  a  sleep-inducer,  316 

Hands,  cold,  196 

''Hardening"  theory,  in  practice,  372; 
objections  to,  233,  371 

Harelip,  25,  230 

Head,  changes  in,  due  to  rickets,  125; 
perspiration  of,  in  rickets,  260 ;  want 
of  symmetry  in  its  formation,  225 

Headache,  as  a  symptom,  137;  due  to 
eye-strain,  343 

Hearing,  first  manifestations  of,  65 

Heart-biirn,  during  pregnancy,  6 

Heart  trouble,  signs  of,  293 

Heat-rash,  268 

Heating  of  the  nursery,  19 

Height,  gain  in,  62 

Hernia,  causes,  299;  characteristics  of, 
299;  due  to  crying,  395;  treatment, 
300 

Herpes,  272 

Hiccough,  cause  and  cure  of,  208 

Hip  disease,  250 

Hives,  274 

Hoarseness,  various  causes  of,  235 

Hominy,  119 

Honey,  426 

Hydrocephalus,  137,  298 

Hygiene  and  sanitation,  359-375 ;  baby 
powder,  368 ;  danger  of  typhoid  fever 
to  babies,  367 ;  desirability  of  keeping 
water  on  the  stove,  361 ;  disinfec- 
tants, 364;  disinfecting  paper  money 
from  a  sick-room,  368;  gas-stove  in 
the  nursery,  365 ;  ' '  hardening  "  the- 
ory, 371,  3f2;  how  long  do  diphthe- 
ria germs  linger .'  365 ;  overstudy  as 
a  cause  of  chorea,  374 ;  physical  ex- 
ercise for  girls,  367;  plants  in  the 
bedroom,  361;  proper  and  improper 
filters,  362;  quinine  as  a  preventive 
of  fever  and  ague,  364 ;  rational  and 
injurious  school  work.  373:  school- 
lunch,  373  ;  sulphur  for  disinfection, 
.363;  susceptibility  to  second  attacks 
of  disease,  367;  temperature  of  the 
nursery  and  the  bedroom.  364 ;  treat- 
ment of  nervous  children,  369;  vac- 


INDEX 


457 


cmation,  359,  360 ;  value  of  water  in 

rheumatism,  369 
Hypophosphite,  333 
Hypnotics,  warning  against,  395 
Hysterical  peculiarities,  265 

Ice-bag,  use  of,  in  sprains,  173 

Ice-cream,  120,  434 

Illness,  136-161,  277-301;  breathing, 
140;  cathartics,  159;  characteristic 
eruptions,  146;  cold  compresses,  155; 
common  diseases,  277-301  ;  domestic 
treatment  of,  149-161;  ears,  140;  evi- 
dences of,  136-148;  fevers,  143;  gen- 
eral behavior  during,  135;  giving 
of  an  enema,  160;  head,  face  and 
eyes,  137;  hot  applications,  155;  in- 
vasion period,  145 ;  period  of  isolation, 
147;  poultices,  156;  precautionary 
measures,  150;  remedial  baths,  151- 
155;  signs  about  the  mouth,  138; 
symptoms  of  contagious  diseases, 
144;  throat  troubles,  138;  urine 
and  bowel  discharges,  142;  various 
coughs,  140 ;  voice,  139 ;  vomiting,  141 

Incised  woimds,  169 

Incisors,  development  of,  67 

Incubation,  periods  of,  in  contagious 
diseases,  144 

Indian  corn,  preparations  of,  119 

Inflammatory  diarrhoea,  132,  142 

Influenza,  cough  of,  141 ;  poison  of,  236 

Ingrowing  toe-nails,  357 

Injuries,  treatment  of,  169 

Intermittent  fever,  284 

Intestinal  worms,  212,  213,  295 

Iodoform  gauze  after  confinement,  13 

Ipecac,  syrup  of,  187,  237 

Iron  preparations,  how  to  give,  165 

Iron,  sulphate  of,  364 

Isinglass  plaster,  184 

Ivory  or  dentine,  66 

Jaundice,  297 
Junket,  119 

Kissing,  by  force,  406;   dangers  from 

indiscriminate,  407 
Klebs-Loefaer  baciUus,  281,  366 
Knock-knee,  247,  252 

Lacerated  wounds,  170 

Lactalbumen,  78,  87 

Laryngitis,  235 

Larynx,  seat  of  the  cry  of  croup,  35 

Laxatives,  during  pregnancy,  7;  for 
constipation,  132;  for  indigestion, 
261 ;  for  worms,  212 ;  value  of  fruits, 
107,  254 

Left-handedness,  312 

Lemon-juice,  as  an  antidote  for  alkali- 
poisoning,  180 

Lifting  the  baby,  proper  method  of, 
399 

Light,  first  recognition  of,  65 


Light  and  air,  value  of,  in  the  nursery, 
18 

Limbs,  disorders  of,  247;  possibly  over- 
burdened, 248 ;  weakness  of,  250 

Lime-water,  as  an  emetic,  180;  for 
burns,  173 ;  for  colic,  187 ;  for  rickets, 
227;  for  sprue,  200;  in  heart-burn 
of  pregnancy,  7;  injurious  quan- 
tity, 421;  to  be  added  in  sterilizing 
food,  99 

Limp,  significance  of,  250 

Linseed-oil,  for  burns,  173 

Lip-sucking,  306 

Lips,  cracked,  218 

Liquid  diet,  77-99 

Lisping,  treatment  of,  224 

Listerine,  uses  of,  236 

Litmus-paper,  use  of,  261 

"  Liver  troubles,"  261 

Lymphatic  troubles,  caused  by  measles, 
290 

Macaroni,  119 

Magnesia,  as  a  laxative,  254;  as  an 
emetic,  180 

Magnesia  preparations,  for  the  heart- 
bum  of  pregnancy,  7 

Malarial  disorders,  283,  284 

Malt-sugar,  as  substitute  for  milk- 
sugar,  79 

Mark,  on  baby's  face,  220,  221 

Massage,  for  constipation,  130,  256 

Measles,  characteristics  of,  289 ;  compli- 
cations, 290;  eruption  of,  146,  267; 
incubation  period  of,  144;  isolation 
period,  147 ;  period  of  invasion,  145 

Measure,  for  milk  and  water,  94 

Measurements,  of  boys  and  girls,  308 

Measuring-glass,  for  medicines,  182; 
for  milk  mixtures,  97 

Meat,  112 ;  beef  and  mutton,  112 ;  dis- 
taste for,  447 ;  poultry,  112 ;  salted  and 
smoked,  112;  when  admissible,  105 

Medicine  chest,  182 

Medicines,  administration  of,  162-168; 
castor-oil,  165;  for  household  use, 
182-189;  in  solid  form,  166;  iron 
preparations,  165;  liquid,  163;  rules 
for  the  sick-room,  168;  swallowing 
made  easy,  167 

Melons,  value  of,  121 

Membranous  croup,  280 

Meningitis,  causes  of,  140,  297 

Mensti'uation,  effect  of,  upon  the 
mother's  milk,  38 

Milk,  constituents  of,  86 ;  during  the 
second  year,  101;  goat's  and  ass's, 
412 ;  hot,  for  an  attack  of  croup,  215 ; 
impure,  420 ;  in  the  nursing  mother's 
diet,  37;  laboratories,  89;  model 
dairies,  83;  modified,  88;  of  the 
breast,  77-80:  pure  versus  diluted, 
433;  purity  of  supply,  82;  scum  on 
boiled,  419 ;  smuggled  into  the  bill  of 
fare,  430 ;  sterilized,  420,  421 ;  sudden 


458 


INDEX 


curdling  of,  261 ;  tests  of  ricliiie8s,419 ; 
warning  against  sour,  419 

Milk-crust,  353 

"Milk"  teeth,  66 

Milk  sugar,  78 

Mint  tea,  for  colic,  135 

Mixed  feeding,  417 

Model  milk-farms,  83 

Modified  milk,  88 

Molars,  development  of,  67;  "six-year- 
old,"  68 

Molasses,  426 

Moles,  25 

Monthly  nurse,  the,  qualifications  of,  8 

''Morning  sickness"  of  pregnancy,  6 

Morphia,  in  convulsions,  178 

Mosquitoes,  as  breeders  of  malaria,  285 

Mother,  care  of,  385-393;  diet  of  a 
nursing,  390 ;  drying  up  the  mother's 
milk,  391 ;  effect  of  the  mother's  diet 
upon  the  child's  teething,  417 ;  excess 
of  abdominal  fat,  392 ;  falling  out  of 
the  hair  after  confinement,  393 ;  ner- 
vousness in  the  mother  as  a  cause 
of  baby's  colic,  385;  "nursing  sore 
mouth."  391;  sensitive  breast,  387; 
sore  nipples,  388 

Motherhood,  preparation  for,  3-17 

Mothers'  marks,  220,  221 

Mother's  milk,  77-80 

Mouth,  as  affected  by  illness,  138 ;  sore, 
202,  203;  washing  of  the,  404 

Mouth-breathing,  198 

Muffins,  inadmissibility  of,  118 

Mumps,  contagiousness  of,  292 ;  incuba- 
tion period  of,  145 ;  isolation  period, 
148;  period  of  invasion,  146 

Muscles,  development  of,  64 

Mustard,  as  an  emetic,  186 

Mustard-pack,  in  convulsion,  178; 
-plaster,  157,  406 

Mutton,  digestibility  of,  112 

Mutton  broth,  value  of,  101 

Nail-biting.  304 

Napkins,  46-49 

Narcotics,  warning  against,  395 

Nasal  catan-h,  237,  238,  239 

Navel,  growth  on,  226 ;  protruding,  300 

Navel-string,  separation  of,  28 

Nettle-rash,  274 

Near-sight,  as  cause  of  stumbUng,  229 

Nervousness,  definition  of,  402 ;  in  con- 
nection with  bed-wetting,  207 ;  in  the 
mother  as  a  cause  of  baby's  colic, 
385;  tendency  to,  74;  treatment  of, 
369 

New-born,  first  care  of  the,  25-29 

Night  feeding,  92;  garments,  53,  377, 
378 ;  meal,  dropping  of,  314 ;  terrors, 
32,  320 

Night  lights  in  the  nursery,  22,  318 

Nipple-shield,  37 

Nipples,  cracked,  remedies  for,  7 ;  sore, 


Nitre,  sweet  spirits  of,  for  fever,  188 
Nitrogenous  elements  of  breast  milk, 

78 

Nose,  obstructions  in,  198 ;  of  the  new- 
born, cleansing  of,  28 ;  persistent  itch- 
ing of,  214 ;  removal  of  foreign  bod- 
ies, 175 

Nosebleed,  176,  210 

Nostrils,  as  affected  by  illness,  138 

Nursery,  appointments  of  the,  18-29; 
chair,  teaching  the  use  of,  399;  fur- 
nishings, 23 ;  light  and  air,  18 ;  lights 
in  the,  22;  perplexing  points  in  the 
nursery  routine,  394-407;  proper 
temperature  of,  22;  routine,  30-39; 
ventilation  and  heating.  19 

Nursing,  accompanied  by  colic,  195; 
and  bottle-feeding  combined,  414; 
during  pregnancy,  315 

Nursing-bottles,  94 

"Nursing  sore  mouth,"  391 

Nutrition,  imperfect,  310,  445 

Oatmeal,  as  a  laxative,  254;  constitu- 
ents of,  104;  value  of,  426,  428 

Oatmeal-gruel,  99,  424,  427;  -water,  99, 
261 

Oiled  silk,  for  poultices,  158;  to  cover 
dressings,  185 

Olive  oil.  various  uses  of,  186 

Onions,  117 

Opium,  preparations  of,  188 

Orange,  as  a  laxative,  254;  when  per- 
missible, 107,  430 

Orange  juice,  value  of,  in  infantile 
scurvy,  127 

Outgrowing  defects,  73 

Overalls,  57 

Overfeeding,  apparent,  263,  443 ;  conse- 
quences of,  159 

Overstudy,  75 

Oxalic  acid,  antidote  for,  180 

Oysters,  permissibility  of,  114 

Palate,  cleft,  230 

Paregoric,    for    pain,   188;    for  colds, 

237;  for  summer  complaint,  263;  in 

colic,  194 
Paris  green,  antidote  for,  180 
Pasteurization,  as  distinguished  from 

sterilization,  98 ;  of  the  milk  supply, 

86 
Pastries,  objection  to,  120 
Patches,    n  tongue,  199 
Peaches,  value  of,  107,  254 
Pears,  120,  254 
Peas,  116 
"Peeling,"  in   German  measles,  291; 

in  scarlet  fever,  289 
Peppermint,  spirit  of,  187,  194 
Permanent  teeth,  development  of,  68 
Perspiration,  of  rickets,  124,  260 
Peruvian  bark,  275,  285 
Phimosis,  as  cause  of  bed-wetting,  207; 


INDEX 


459 


causing  the  stumbling  habit,  229; 
description  of,  74 

Pharyngitis,  293 

Pharynx,  affections  of,  139;  obstruc- 
tion of,  199 

Phosphate,  for  strengthening  the 
teeth,  334;  of  lime,  in  breast  milk, 
78 ;  of  soda  as  a  laxative,  261 

Phosphorous  poisoning,  antidote  for, 
180 

Pigeon-breast,  due  to  rickets,  125 

Pillow,  of  fir  needles,  319;  of  hops, 
319 ;  value  of,  318 

Pin-worms,  213,  323 

Pinning-blanket,  376 

Pink-eye,  344 

Plant-poisoning,  181 

Plants,  in  the  bedroom,  361 

Plaster,  mustard-,  157 

Playing  with  young  children  to  be 
discountenanced,  75 

Pleurisy,  false  diagnosis  of,  236 

Pneumonia,  application  of  poultices  in, 
156;  cough  of,  141;  cry  in,  35;  er- 
rors in  diagnosis,  236;  oiled-silk 
jacket  in,  159 

Poisoning,  accidental,  179;  due  to 
plants,  181 

Pop-corn,  427 

Porridges,  how  to  prepare,  106;  value 
of,  104 

Posture  as  a  symptom,  136 

Potash,  antidote  for,  180 

Potatoes,  often  given  too  early,  107; 
sweet,  115 ;  when  permissible,  107 

Pott's  disease,  251 

Poultices,  how  to  apply,  157;  various 
kinds  of,  156 

Poultry,  admissibility  of,  in  the  diet, 
112 

Precocity,  75 

Pregnancy,  alkalis  against  discomforts 
of,  7 ;  baby  basket,  13 ;  bath  during, 
5 ;  care  of  the  breasts  and  nipples,  7 ; 
constipation  in,  4 ;  diet  during,  3 ;  dis- 
comforts of,  5;  disinfectants  after 
confinement,  12;  dress  and  clothing 
for,  4 ;  effervescing  waters  admissible, 
6;  examination  of  urine  advisable, 
16;  general  care  during,  3-18;  heart- 
burn, 6;  "morning  sickness,"  6;  lax- 
atives, 7;  nursing  during,  315;  out- 
fit of  the  lying-in  chamber,  10; 
swelling  of  the  veins,  4 ;  time  of  con- 
finement, 9 

Premature  child,  feeding  of,  438 

Prickly  heat,  266 

Proportions  in  height,  62 

Proteids,  in  cow's  milk,  86;  in  the 
nursing  mothers  diet,  37;  of  breast 
milk,  78 ;  proportion  of,  109 

Prunes,  when  permissible,  107 

Psoriasis,  270 

Pulmonary  troubles,  symptoms  of,  140 

Pulse,  rate  of,  in  illness,  140 


Pumpkin-seed,  against  tapeworm,  296 
Punctured  wounds,  109 
Purgatives,  7,  107,  132,  212,  261 

Quinine,  285,  364 
Quinsy,  293 

Rachitis,  124,  125,  225,  228,  240,  260 

Ragged  wounds,  170 

Red-gum,  269 

Remedies,  for  household  use,  182-189; 
for  malarial  fever,  284 

Rennet  whey,  134 

Respiration,  in  health  and  illness,  140 

Restlessness,  as  a  symptom,  136 

Rheumatism,  198,  291,  369 

Rhinitis,  236 

Rhubarb,  275 

Rice,  in  the  diet,  119 ;  puddings,  120 

Rickets,  bow-legs  due  to,  228;  causes 
and  cure  of,  125;  causing  delay  in 
teething,  331;  changes  due  to,  125, 
225 ;  sweating  of  the  head  suggestive 
of,  240,  260 ;  symptoms  of,  124 

Ringworm,  271 

Rocking  habit,  31,  396 

Rotheln,  290 

Round  shoulders,  causes  of,  226;  ten- 
dency to,  73 

Rouud-worm,  323 

Rubber  diaper,  objections  to,  48 

Rubber  nipples,  as  "comforters,"  31, 
316 ;  care  of,  94,  203 ;  proper  kind,  94 

Rubber  plaster,  184 

Rupture,  causes  of,  299 ;  characteristics 
of,  299;  due  to  crying,  395;  treat- 
ment, 300 

Sage-tea,  431 

Sago,  119 

Saint  Vitus's  dance,  293,  325,  374 

Saliva,  development  of,  309;  increased 

flow  in  teething,  332 
Salt,  as  an  emetic,  186 ;  for  an  enema, 

186;  inordinate  fondness  for,  435 
Salts,  in  cow's  milk,  86 ;  of  breast  milk, 

78 
Salicylic  acid,;f  or  removal  of  warts,  222 
Sanitation  and  hygiene,  359-375 
Santonine,  as  a  remedy,  212 ;  as  affect- 
ing the  urine,  142 
Scalds,  treatment  of,  173 
Scalp,  cleansing  of,  in  first  bath,  28; 

milk-crust,  353;   strengthening  thin 

hair,  351 ;  use  of  soap,  352 ;  washing 

of,  352 
Scarlatina,    caused    by    contaminated 

milk,  84 ;  characteristics  of,  267,  289 ; 

complications,  290 ;  eruption  of,  146 ; 

incubation     period,     144;      isolation 

period,  147;  meaning  of  term,  282; 

period  of  invasion,  145 
School-lunch,  373;  -work,  rational  and 

injurious,  373,  374 
Scrofula,  treatment  for,  295 


460 


INDEX 


Scurvy,  causes  and  cure,  127;  infan- 
tile, symptoms  of,  126 

Sea  bathing,  effects  of,  39 

Seborrhcea,  271,  351 

Second  teeth,  68 

Sedatives,  394 

Senses,  special,  development  of,  65 

Shingles,  272 

Shoes,  harm  done  by  improper,  357; 
proper,  54,  197,  382 ;  stiff  soles,  381 

Shoulders,  drooping,  311 ;  round,  226 

Silk,  value  of,  as  underwear  mateiaal, 
377 

Sitting,  attempts  at,  64,  396 

Skimmed  cream,  102 

Skin,  chafed,  218;  diseases  of,  266-276; 
in  fever,  143 

Sleep,  disorders  of,  32;  duration  of, 
30-32;  importance  of  regular  hours, 
32 ;  night  terrors,  33 ;  nocturnal  epi- 
lepsy, 33;  versus  food,  422;  walking 
in,  34 

Sleeping,  best  place  for,  397 ;  causes  of 
night  terror,  320;  experimenting 
with  anodynes,  317;  fir-pillow,  319; 
hammock  as  a  sleep  inducer,  316; 
lying  on  the  stomach,  320;  night- 
Light  in  the  nursery,  318 ;  objections 
to  having  children  sleep  with  adults, 
319;  position  for  sleep,  320;  rubber 
nipple  and  sugar-rags  as  "com- 
forters," 316;  special  points  con- 
nected with,  316-323;  value  of  the 
pillow,  318 ;  worms  as  possible  causes 
of  talking  in  sleep,  322 

Small-pox,  incubation  period  of,  145 

Smell,  first  evidences  of,  66 

Soap,  desirableness  of,  in  bathing,  325 ; 
-suds,  as  an  emetic,  180;  supposi- 
tories of,  255,  256;  use  of,  on  the 
head,  352 

Socks,  40 

Soda,  bicarbonate  of,  for  burns,  173 ;  as 
a  laxative,  255 

Soda-mint,  187,  196 

Sodium  bicarbonate,  for  heart-burn  of 
pregnancy,  7 

"  Sore  mouth,"  202,  203 

Sore  throat,  139,  292 

Soups,  115 

Spasmodic  croup,  cough  of,  140 ;  mean- 
ing of,  282 

Speech,  development  of,  66,  310 

Spinach,  117,  254 

Spine,  curvature  of,  73;  tuberculous 
affection  of,  251 ;  weakness  of,  251 

Splinter,  removal  of,  171 

Sponges,  suitable  for  baby's  bath,  16 

Sprains,  treatment  of,  173 

Sprue,  200,  202 

Squills,  237 

Squint,  339 

Stammering,  treatment  of,  222 

Starch,  conversion  of,  into  sugar,  79; 
excess  of,  as  cause  of  rickets,  126 


Steak,  when  admissible,  105 
Sterilization,  of  food,  98;  practised  in 

model  dairies,  84 
Sties,  342 
Stimulants,  for  the  nursery  pharmacy, 

188;    for  shock,  174;   for  revival  of 

the  drowning,  178;  in  fever,  294;  in 

poisoning  accidents,  181;  objections 

to,  122 
Stocking-supporters,  381 
Stockings,  40,  196,  378,  380,  382 
Stomach  indigestion,  134,  264 
"Stomach'"  teeth,  67 
Stools,  in  illuess,  142,  265 
Stoop,  tendency  to,  227 
Stoves,  for  the  nursery,  20,  365 
Strawberry,  value  of,  121,  429 
String-beans,  116 
Stumbling  habit,  228 
Stupes,  application  of,  156 
Suckling,  34-38;  care  of  the  nipple,  36; 

evidences  of  suitable  breast  milk,  34 ; 

signs  of  unsuccessful,  35 
Sugar,  in  cow's  milk,  86;  objection  to 

excessive  use  of,  107,  431 
Sugar-teats,  objections  to,  31,  317 
Sulphate   of  copper,  as    antidote   for 

phosphorus  poisoning,  180 ;  doses  of, 

189 
Sulphites,  275 
Sulphur  fumigations,  363 
Summer  complaint,  262 ;  diarrhoea,  132 ; 

dress,  378 
Supper-meal,  108 
Suppositories,  during  pregnancy,  7 ;  for 

constipation,  131,  255,  256 
Surgery,  domestic,  169-177 
Surgical,    household    implements    for 

emergencies,  183 
Sweets,  objections  to,  122 
Swollen  veins  during  pregnancy,  4 
Syringes,  various  kinds  of,  160 

Tannic    acid,    as    antidote    for    plant 

poisoning,  181 ;  doses  of,  189 
Tannin  and  glycerin,  as  a  remedy  for 

cracked  nipples,  7 
Tape-worm,  295 
Tapioca,  119 

Taste,  first  manifestations  of,  65 
Tea,  effect  of,  on  children,  437 
Tear-glands,  development  of,  309 
Teeth,  care  of,  69 ;  development  of,  66- 
70;   discoloration,  335;    early  decay, 
334;  effect  of  early  feeding,  333;  fill- 
ing of  the  first,  337 ;  gritting  of,  211, 
323;    peculiarities,    336;    permanent 
set,   68;   removing   redundant,    336; 
rudimentary  condition  before  birth, 
66;  strengthening  of ,  333;  temporary 
set,  67 ;  unusual  absence  of  upper  in- 
cisors, 337;   use  of  the  tooth-brush, 
334 ;  various  parts  of  the,  66 
Teething,  as  a  cause  of  colic,  194;  as 
affected  by  the  mother's  diet,  417; 


INDEX 


461 


diet  in  slow,  444 ;  disturbances  in 
connection  with,  70;  drooling,  332; 
late,  331;  normal  and  painful,  328; 
process  of,  70 

Temperature,  in  fever,  143;  of  baby's 
first  bath,  27 ;  proper,  of  the  nursery, 
22,364 

Temporary  teeth,  67 

Throat,  care  of  sensitive,  239 ;  removal 
of  foreign  bodies  from,  176 

Throat  troubles,  138 

"Thrush,"  cause  of,  202 

Thumb-sucking,  effects  of,  302 ;  to  pro- 
duce sleep,  31 

Toast,  105 

Toe-nails,  ingrowing,  357 

Toes,  depressed,  382 ;  turning  in  of,  248 

Tongue,  coated,  138,  201,  259;  patches 
on,  199 ;  tie,  229 

Tonics,  275 

Tonsilitis,  as  related  to  rheumatism, 
292;  symptoms  of,  138;  varieties  of, 
293 

Tonsils,  as  affected  in  illness,  139 ;  en- 
larged, 138,  198;  removal  of,  205; 
swollen,  203 

Tooth-brush,  use  of,  334 

Top-milk,  value  of,  88 

Touch,  first  manifestations  of,  65 

Tricuspids,  appearance  of,  69 

Truss,  use  of,  in  hernia,  300 

Tubercular  bacillus,  affecting  spine,  251 

Turpentine,  oil  of,  against  tape-worm, 
296;  spirits  of,  in  hot  applications, 
156 

Typhoid  fever,  286,  287,  367 

Umbilical  cord,  28;  growth,  225 
Urinary  obstruction  in  the  new-born,  25 
Urine,    advisability    of    examination 

during  pregnancy,  16;    changes  in, 

due  to  illness,  142 
Urticaria,  274 
Uvula,  enlarged,  199 

Vaccination,  359,  360 

Vapor  bath,  154 

Varioloid,  incubation  period  of,  145 

VaseUne,  uses  of,  26,  130,  160,  185 

Veal,  unsuitability  of,  112 

Vegetables,  in  the  diet  of  children, 
115-118 

Veil,  objections  to,  399 

Veins,  swollen,  during  pregnancy,  4 

Ventilation,  in  the  nursery,  19 ;  protec- 
tion from  drafts,  397 

Verdigris,  antidote  for,  180 

Vermifuges,  212 

Vernix  caseosa,  removal  of,  26 


Vinegar,  as  antidote  for  alkali-poison- 
ing, 180 

Vision,  beginning  of,  309 

Voice,  changes  in,  due  to  illness,  139; 
roughness  of,  206 

Vomiting,  as  a  symptom,  134;  exces- 
sive, 443 ;  in  scarlet  fever,  289 ;  vari- 
eties of,  141 

Walking,  beginning  of,  64 ;  difficulties 
of,  247-252 ;  disinclination  to  put  the 
foot  down,  249;  knock-knee,  252; 
possible  dangers  from  early,  247; 
possibly  overburdened  limbs,  248; 
Pott's  disease,  251;  signification  of 
a  limp,  250;  tuming-in  of  the  toes, 
248;  weak  ankles,  252;  weak  Umbs, 
250 

Wardrobe,  44-58,  376-384 

Warts,  removal  of,  221 

Water,  as  a  drink,  122 ;  chief  constitu- 
ent of  breast  milk,  78 ;  for  constipa- 
tion, 129 ;  in  cow's  milk,  86 ;  need  of, 
to  quench  thirst,  432;  value  of,  in 
rheumatism,  369 

''Water  on  the  brain,"  137,  298 

Wax,  impaction  of,  in  the  ear,  346,  349 

Weak  ankle,  247,  252 

Weaning,  dropping  the  night  meal, 
314;  feeding  after,  418;  mode  of, 
313-315;  nursing  during  pregnancy, 
315 ;  system  in,  313 

Weight,  at  various  ages,  308 ;  gain  in, 
60;  normal,  307 

Wet-nurse,  selection  of,  408 

Wheaten  preparations,  value  of,  119 

Whey,  134 

Whole-wheat  flour,  104 

Whooping-cough,  contagion  of,  245 
first  symptoms,  243 ;  incubation  pe 
riod,  145;  period  of  isolation,  147: 
severity  of,  in  relation  to  age,  245: 
signs  of,  141 ;  supposed  ignorance  of 
physicians  concerning,  244 

"Whopper- jaw,"  230 

"Wind-sucking,"  414 

Winter  clothing,  379 

Wisdom  teeth,  appearance  of,  69 

Witch-hazel  extract,  use  of,  172 

Woolen  garments,  value  of,  45,  380 

Worms,  as  possible  causes  of  talking 
in  sleep,  322;  cause  of  pin-worms, 
213;  supposed  signs  of,  211,  212; 
tape-worm,  295 

Wounds,  treatment  of,  169 

Zinc  ointment,  321 ;  plaster,  184 
Zoster,  272 
Zwieback,  105 


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